1326374000 NPI number — NORTH DAVIS NEUROLOGY INC

Table of content: (NPI 1326374000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326374000 NPI number — NORTH DAVIS NEUROLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH DAVIS NEUROLOGY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326374000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-294-6907
Provider Business Mailing Address Fax Number:
801-294-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 W ANTELOPE DR
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-1156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-825-8900
Provider Business Practice Location Address Fax Number:
801-825-2186
Provider Enumeration Date:
10/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHOWDHURY
Authorized Official First Name:
ARIF
Authorized Official Middle Name:
A
Authorized Official Title or Position:
NEUROLOGIST
Authorized Official Telephone Number:
801-825-8900

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  97335689-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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