Provider Demographics
NPI:1851394639
Name:MIDDLETON, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:MIDDLETON
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 1:181 E 5600 S
Mailing Address - Street 2:STE 130
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6127
Mailing Address - Country:US
Mailing Address - Phone:801-266-8664
Mailing Address - Fax:801-264-9031
Practice Address - Street 1:181 E 5600 S
Practice Address - Street 2:STE 130
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6127
Practice Address - Country:US
Practice Address - Phone:801-266-8664
Practice Address - Fax:801-264-9031
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1507231205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63490Medicare UPIN
UT000001480Medicare ID - Type Unspecified