Provider Demographics
NPI:1871885111
Name:REGINA W. DRUEDING, M.D. PC
Entity type:Organization
Organization Name:REGINA W. DRUEDING, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DRUEDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-298-2332
Mailing Address - Street 1:415 MEDICAL DR STE D201
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4983
Mailing Address - Country:US
Mailing Address - Phone:801-298-2332
Mailing Address - Fax:801-298-5018
Practice Address - Street 1:415 MEDICAL DR STE D201
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4983
Practice Address - Country:US
Practice Address - Phone:801-298-2332
Practice Address - Fax:801-298-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188606-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B62847Medicare UPIN