Provider Demographics
NPI:1225255094
Name:UINTA EAR, NOSE & THROAT, PC
Entity type:Organization
Organization Name:UINTA EAR, NOSE & THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-783-8364
Mailing Address - Street 1:196 ARROWHEAD DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-8752
Mailing Address - Country:US
Mailing Address - Phone:307-783-8364
Mailing Address - Fax:
Practice Address - Street 1:196 ARROWHEAD DR
Practice Address - Street 2:SUITE 5
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-8752
Practice Address - Country:US
Practice Address - Phone:307-783-8364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4309A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty