Provider Demographics
NPI:1104830884
Name:CALL, NATHAN H
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:H
Last Name:CALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-8504
Mailing Address - Country:US
Mailing Address - Phone:435-752-6105
Mailing Address - Fax:
Practice Address - Street 1:1652 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-8504
Practice Address - Country:US
Practice Address - Phone:435-752-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3231611205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG30882Medicare UPIN
UT000063923Medicare PIN