Provider Demographics
NPI:1700587169
Name:TRUE MED
Entity type:Organization
Organization Name:TRUE MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BOWMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:801-821-8616
Mailing Address - Street 1:35 S 400 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5324
Mailing Address - Country:US
Mailing Address - Phone:801-821-8616
Mailing Address - Fax:
Practice Address - Street 1:35 S 400 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5324
Practice Address - Country:US
Practice Address - Phone:801-821-8616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty