Organization
INTERMOUNTAIN ALLERGY & IMMUNOLOGY CLINIC
Active
Other names
Intermountain Allergy & Asthma
Organization subpart
No
Provider details
NPI number
Authorized official
DUANE HARRIS (PARTNER)
(801) 363-4071
Entity
Organization
Contact information
Practice address
6065 FASHION BLVD, STE 255, SALT LAKE CITY, UT 84107-7381
(801) 266-4115
Mailing address
6065 FASHION BLVD, STE 255, SALT LAKE CITY, UT 84107-7381
(801) 266-4115
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO1561
GROUP RAILROAD MEDICARE
—
Enumeration date
09/06/2006
Last updated
01/11/2011
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