Organization Name: | INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC |
NPI Number: | 1487687430 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID EDGAR ALLEN (MEDICAL DOCTOR) |
Mailing Address: | 3860 Jackson Ave Ste 2 Ogden |
State: | UT US |
Postal Code: | 844031997 |
Phone Number: | 8016270515 |
Fax Number: | 8016270517 |
NPI Enumeration Date: | 07/09/2006 |
NPI Last Update Date: | 01/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 159426-1205 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | UT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |