Provider Demographics
NPI:1417390410
Name:KATIGBAK, PAUL ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEX
Last Name:KATIGBAK
Suffix:
Gender:M
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:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-3400
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 3400
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3281
Practice Address - Country:US
Practice Address - Phone:801-387-3400
Practice Address - Fax:801-387-3420
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11864220-1205207RI0011X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program