| Organization Name: | GREGORY IVERSON FAMILY MEDICINE PLLC |
| NPI Number: | 1720379936 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY DENNIS IVERSON (FAMILY PHYSICIAN/MANAGING MEMBER) |
| Mailing Address: | 142 South 50 East Coalville |
| State: | UT US |
| Postal Code: | 840170865 |
| Phone Number: | 4353364403 |
| Fax Number: | 4353365570 |
| NPI Enumeration Date: | 04/21/2011 |
| NPI Last Update Date: | 11/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 7261660-1204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |