| Wasatch Peak Family Practice Inc | |
|
1580 W Antelope Dr Suite 200 Layton UT 84041-1160 | |
| (801) 773-4770 | |
| (801) 773-4776 |
| Full Name | Wasatch Peak Family Practice Inc |
|---|---|
| Speciality | General Practice |
| Location | 1580 W Antelope Dr, Layton, Utah |
| Authorized Official Name and Position | Lynette Chowning (OFFICE MANAGER) |
| Authorized Official Contact | 8017734770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Peak Family Practice Inc 1580 W Antelope Dr Suite 200 Layton UT 84041-1160 Ph: (801) 773-4770 | Wasatch Peak Family Practice Inc 1580 W Antelope Dr Suite 200 Layton UT 84041-1160 Ph: (801) 773-4770 |
| NPI Number | 1790998359 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 05/08/2015 |
| Medicare PECOS PAC ID | 5991795692 |
|---|---|
| Medicare Enrollment ID | O20040514000683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790998359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Kevin L Gardner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790897452 PECOS PAC ID: 9931135266 Enrollment ID: I20050708000700 |
| Provider Name | David E Butters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932272598 PECOS PAC ID: 7113011032 Enrollment ID: I20070921000521 |
| Provider Name | Jeffery L Degrauw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780796441 PECOS PAC ID: 1951391655 Enrollment ID: I20101025000677 |
| Provider Name | Courtney R Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205915410 PECOS PAC ID: 6709941339 Enrollment ID: I20120823000365 |
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