Individual
DAVID DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
5312 W SHAGGY PEAK DR, RIVERTON, UT 84096-6418
(801) 792-3635
(801) 446-1305
Mailing address
5312 W SHAGGY PEAK DR, RIVERTON, UT 84096-6418
(801) 792-3635
(801) 446-1305
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
51755361206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51755361206
STATE LICENSE
UT
Enumeration date
02/09/2007
Last updated
01/27/2022
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