Provider Demographics
NPI:1467637926
Name:OGDEN EAR NOSE & THROAT PC
Entity Type:Organization
Organization Name:OGDEN EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-476-0342
Mailing Address - Street 1:425 E 5350 S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6946
Mailing Address - Country:US
Mailing Address - Phone:801-476-0342
Mailing Address - Fax:801-476-9088
Practice Address - Street 1:425 E 5350 S
Practice Address - Street 2:SUITE 130
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6946
Practice Address - Country:US
Practice Address - Phone:801-476-0342
Practice Address - Fax:801-476-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT952927061205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528150997002Medicaid
UT528150997002Medicaid