Basic Information
Provider Information
NPI: 1427378603
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALEXANDER
FirstName: RILEY
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 30180
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841300180
CountryCode: US
TelephoneNumber: 7656239930
FaxNumber:  
Practice Location
Address1: 4401 HARRISON BLVD
Address2:  
City: OGDEN
State: UT
PostalCode: 844033195
CountryCode: US
TelephoneNumber: 8013872800
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2010
LastUpdateDate: 05/26/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZC0500X9645195-1205UTY Allopathic & Osteopathic PhysiciansPathologyCytopathology

No ID Information.


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