INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC NPI 1487687430

NPI Information

INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC is a specialist in Ogden, UT. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC NPI is 1487687430. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3860 JACKSON AVE STE 2
OGDEN, UT
ZIP 84403-997
Phone: (801) 627-0515
Fax: (801) 627-0517

The provider's authorized official is David Edgar Allen .
The authorized official title is Medical Doctor and has the following contact phone number (801) 627-0515.

The CLIA number assigned to this NPI record is 46D2137595 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 1/7/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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