Provider Demographics
NPI:1508868563
Name:RADLEY, KAREN M (MD PC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:RADLEY
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
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Mailing Address - Street 1:965 E 700 S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4086
Mailing Address - Country:US
Mailing Address - Phone:435-673-4644
Mailing Address - Fax:855-222-7622
Practice Address - Street 1:965 E 700 S STE 300
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4086
Practice Address - Country:US
Practice Address - Phone:435-673-4644
Practice Address - Fax:855-222-7622
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UTZ67908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDD8580OtherPALMETTO GBA-RAILROAD MEDICARE
UTH25604Medicare UPIN
UT005712601Medicare PIN