Basic Information
| Provider Information | |||||||||
| NPI: | 1568545945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | REED | ||||||||
| MiddleName: | YOUNG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 NORTH CENTER ST | ||||||||
| Address2: | #800 | ||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840437406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019901911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1380 EAST MEDICAL CENTER DRIVE | ||||||||
| Address2: | DIXIE REGIONAL MEDICAL CENTER | ||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352511000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 48372-020 | WI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1558391763 | 05 | UT | MEDICAID |