Individual
GREGORY D IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
142 SOUTH 50 EAST, COALVILLE, UT 84107
(435) 336-4403
(435) 336-5570
Mailing address
PO BOX 865, COALVILLE, UT 84017-0865
(435) 336-4403
(435) 336-5570
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
365
NE
207Q00000X
Family Medicine Physician
7261660-1204
UT
Other
Enumeration date
04/28/2006
Last updated
05/04/2010
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