Individual
ILYSSA GOLDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 E 3900 S, SALT LAKE CITY, UT 84124-1300
(801) 268-7111
(801) 296-6199
Mailing address
380 N 200 W, SUITE 209, BOUNTIFUL, UT 84010-7079
(801) 298-1300
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
8295697-1205
UT
2085R0202X
Diagnostic Radiology Physician
G78242
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G782420
BLUE SHIELD
CA
05
—
00G782420
—
CA
01
—
10000007105001
REGENCE BCBSU
UT
01
—
1063448371
UNIVERSITY OF UTAH HEALTH PLANS
UT
05
—
1063448371
—
UT
01
—
138686
PEHP
UT
01
—
567412
DESERET MUTUAL BENEFIT ADMINISTRATORS
UT
01
—
939166
WINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN
UT
01
—
P01075932
RAILROAD MEDICARE
UT
Enumeration date
06/26/2006
Last updated
01/17/2013
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