Provider Demographics
NPI:1588393821
Name:MOJAVE HEALTH, LLC
Entity type:Organization
Organization Name:MOJAVE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-574-9146
Mailing Address - Street 1:965 E 700 S STE 205
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4085
Mailing Address - Country:US
Mailing Address - Phone:435-574-9146
Mailing Address - Fax:435-574-9147
Practice Address - Street 1:965 E 700 S STE 205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4085
Practice Address - Country:US
Practice Address - Phone:435-602-3272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8531715-1204OtherSTATE LICENSE