Provider Demographics
NPI:1396778148
Name:RICH, NATHAN TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:TERRY
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:SUITE C-240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-266-0878
Mailing Address - Fax:801-266-2074
Practice Address - Street 1:1034 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3380
Practice Address - Country:US
Practice Address - Phone:801-357-8200
Practice Address - Fax:801-357-8201
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6225454-1205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107048462101OtherSELECT HEALTH
UT000059109Medicare PIN
UT107048462101OtherSELECT HEALTH