Provider Demographics
NPI:1972952828
Name:PREMIER FAMILY MEDICAL - DERMATOLOGY
Entity type:Organization
Organization Name:PREMIER FAMILY MEDICAL - DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-769-2571
Mailing Address - Street 1:275 W 200 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5009
Mailing Address - Country:US
Mailing Address - Phone:801-796-1333
Mailing Address - Fax:801-796-0625
Practice Address - Street 1:1112 E 300 N STE 301
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-4522
Practice Address - Country:US
Practice Address - Phone:801-642-2950
Practice Address - Fax:801-642-2951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty