Brant Wahlen Fonnesbeck, DO

NPI #1033156849 in Logan, Utah

Provider Information

NPI Number: 1033156849
Entity Type: Individual
Name: Brant Wahlen Fonnesbeck, DO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: DO
Enumeration Date: Jun 1, 2006
Last Updated: Feb 26, 2008

Practice Location

Address: 550 E 1400 N STE K
City: Logan
State: Utah
ZIP Code: 84341-2450
Phone: (435) 755-6061

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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