Provider Demographics
NPI:1437253440
Name:DAVIS FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:DAVIS FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-773-7232
Mailing Address - Street 1:3225 W GORDON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8769
Mailing Address - Country:US
Mailing Address - Phone:801-773-7232
Mailing Address - Fax:801-773-9577
Practice Address - Street 1:3225 W GORDON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8769
Practice Address - Country:US
Practice Address - Phone:801-773-7232
Practice Address - Fax:801-773-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055032Medicare PIN