Basic Information
| Provider Information | |||||||||
| NPI: | 1740846450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROGUARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 S 850 E | ||||||||
| Address2: | |||||||||
| City: | KAYSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840372220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014476454 | ||||||||
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| Address1: | 294 S 850 E | ||||||||
| Address2: | |||||||||
| City: | KAYSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840372220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134634802 | ||||||||
| FaxNumber: | 2814624106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | DALLAS | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 8014476454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.