Individual
NICKOLAS GANGWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4403 HARRISON BLVD STE 3875, OGDEN, UT 84403-3332
(801) 387-7950
Mailing address
4403 HARRISON BLVD STE 3875, OGDEN, UT 84403-3332
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10280090-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2014
Last updated
03/17/2018
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