Organization · Type 2 NPI
Custom Medical Services
Adolescent Medicine (Family Medicine) Physician · Roosevelt, UT
NPI number
1669452298
Active
Practice location
RR 3 Box 3053
Roosevelt, UT 84066-9609
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Legal Medicine | 173000000X | V09531 (UT) |
| Adolescent Medicine (Family Medicine) Physician Primary | 207QA0000X | None listed |
| Adult Medicine Physician | 207QA0505X | V09531 (UT) |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | None listed |
Adolescent Medicine (Family Medicine) Physician: A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.
About NPI 1669452298
Custom Medical Services's National Provider Identifier is 1669452298, issued on Jan 19, 2006. The primary taxonomy on file is Adolescent Medicine (Family Medicine) Physician (207QA0000X), and the practice location is in Roosevelt, UT. The record was last updated on Sep 11, 2025.