Brant Wahlen Fonnesbeck DO

NPI 1033156849 - Family Medicine - 207Q00000X

NPI Details
NPI 1033156849
Gender Male
Enumeration Date 06/01/2006
Last Updated 02/26/2008
Entity Type Individual
Active Over 10 years ago
Practice Location
550 E 1400 N STE K
LOGAN UT, 84341-2450, US
Phone (435) 755-6061
Fax
Business Location
325 W LOGAN HWY
PO BOX 328
GARDEN CITY UT, 84028, US
Phone (435) 764-7249
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Utah
License Number 5953772-1204
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According to our database, Brant Wahlen Fonnesbeck DO NPI is 1033156849, taxonomy code is 207Q00000X and license number is 5953772-1204, license state is located at Utah. Brant Wahlen Fonnesbeck DO physically located at 550 E 1400 N Ste K, Logan UT, 84341-2450. NPI Number Brant Wahlen Fonnesbeck DO has the Individual type.

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1033156849 NPI number is provided on an as is basis without warranty of any kind. 1033156849 is maintained by the National Plan & Provider Enumeration System. The contents of Brant Wahlen Fonnesbeck DO are for informational purposes only.