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NPI Profile for CUSTOM MEDICAL SERVICES in ROOSEVELT, UT.
A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adolescent Medicine |
207QA0000X | 08 | Physician/Family Practice | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice | |
Geriatric Medicine |
207QG0300X | 08 | Physician/Family Practice | |
Legal Medicine |
173000000X |
| NPI # | 1669452298 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 01/19/2006 | |
| Last updated | 09/11/2025 - About 9 months ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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CUSTOM MEDICAL SERVICES
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CUSTOM MEDICAL SERVICES