Provider Demographics
NPI:1649469024
Name:D. VERNON CAHOON
Entity type:Organization
Organization Name:D. VERNON CAHOON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-353-5420
Mailing Address - Street 1:1159 E 200 N STE 300
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2037
Mailing Address - Country:US
Mailing Address - Phone:800-353-5420
Mailing Address - Fax:812-330-0099
Practice Address - Street 1:1159 E 200 N STE 300
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2037
Practice Address - Country:US
Practice Address - Phone:800-353-5420
Practice Address - Fax:812-330-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1013985522174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDB9966OtherRR MEDICARE