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Organization

CANYON MEDICAL GROUP LLC

Active
Other names
Treehouse Pediatrics & Family Care LLC
Organization subpart
No

Provider details

NPI number
Authorized official
WENDY WIMMER (MANAGER)
(435) 750-5599
Entity
Organization

Contact information

Practice address
1624 N 200 E STE 160, LOGAN, UT 84341-3175
(435) 750-5599
(435) 750-0861
Mailing address
1624 N 200 E STE 160, LOGAN, UT 84341-3175
(435) 750-5599
(435) 750-0861

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0708814
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
528291883001
UT
Enumeration date
10/10/2007
Last updated
01/23/2023
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