Provider Demographics
NPI:1205093721
Name:DOUGLAS M VOGELER MD PC
Entity type:Organization
Organization Name:DOUGLAS M VOGELER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MALCOM
Authorized Official - Last Name:VOGELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-572-0443
Mailing Address - Street 1:9600 S 1300 E
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3766
Mailing Address - Country:US
Mailing Address - Phone:801-572-0443
Mailing Address - Fax:801-571-1987
Practice Address - Street 1:9600 S 1300 E
Practice Address - Street 2:SUITE 303
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3766
Practice Address - Country:US
Practice Address - Phone:801-572-0443
Practice Address - Fax:801-571-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT159548-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2945095500009Medicaid
UT2945095500009Medicaid