Organization
SHANE D GAGON MD, PC
Active
Other names
CASTLE COUNTRY FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
PAT A STAPLEY (BILLING)
(435) 613-2210
Entity
Organization
Contact information
Practice address
377 NO. FAIRGROUNDS RD., PRICE, UT 84501-4211
(435) 613-2200
(435) 613-2201
Mailing address
377 NO. FAIRGOUNDS RD., PRICE, UT 84501-4216
(435) 613-2200
(435) 613-2201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
361555-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529513346027
—
UT
01
—
DF8294
RAILROAD MEDICARE
UT
Enumeration date
05/24/2007
Last updated
12/01/2010
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