Provider Demographics
NPI:1386884435
Name:ST GEORGE REGIONAL NEUROLOGY PC
Entity type:Organization
Organization Name:ST GEORGE REGIONAL NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAJ
Authorized Official - Middle Name:N
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-688-7800
Mailing Address - Street 1:736 S 900 E
Mailing Address - Street 2:202
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7000
Mailing Address - Country:US
Mailing Address - Phone:435-688-7800
Mailing Address - Fax:435-688-7801
Practice Address - Street 1:736 S 900 E
Practice Address - Street 2:202
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7000
Practice Address - Country:US
Practice Address - Phone:435-688-7800
Practice Address - Fax:435-688-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT269427-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty