Provider Demographics
NPI:1396850707
Name:DRUEDING, REGINA W (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:W
Last Name:DRUEDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-507-9390
Mailing Address - Fax:801-507-9380
Practice Address - Street 1:5171 S COTTONWOOD ST STE 350
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5733
Practice Address - Country:US
Practice Address - Phone:801-507-9390
Practice Address - Fax:801-507-9380
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT188607-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000073771Medicare PIN
UTB62847Medicare UPIN