Organization · Type 2 NPI

Intermountain Medical Group Grand Junction, LLC

Hematology & Oncology Physician · Moab, UT

NPI number 1649883547 Active

Practice location

450 Williams Way
Moab, UT 84532-2185

Fax (435) 719-3529

Specialties and licenses

Taxonomy	Code	License
Hematology & Oncology Physician Primary	207RH0003X	None listed

Hematology & Oncology Physician: An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

23 other providers at this address

NPI record

NPI: 1649883547
Entity type: Organization (Type 2)
Issued: Aug 28, 2020
Last updated: Jun 28, 2024
Status: Active
Subpart: Yes of Intermountain Front Range, Inc.

Other names

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SMMG Satellite - Medical Oncology Moab · doing business as
SMMG Satellite - Medical Oncology Moab · doing business as

Authorized official

Jon McDaniel
VP Finance Medical Group
(303) 272-0231

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1649883547

Intermountain Medical Group Grand Junction, LLC's National Provider Identifier is 1649883547, issued on Aug 28, 2020. The primary taxonomy on file is Hematology & Oncology Physician (207RH0003X), and the practice location is in Moab, UT. The record was last updated on Jun 28, 2024.