Individual
KATIE ROUSSEAU JEANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5801 S FASHION BLVD STE 280, MURRAY, UT 84107-6136
(801) 268-5684
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R4566
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
R4566
TX
207RP1001X
Pulmonary Disease Physician
Primary
12340843-1205
UT
207RP1001X
Pulmonary Disease Physician
R4566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401850901
—
TX
05
—
401850902
—
TX
05
—
401850903
—
TX
Enumeration date
05/20/2013
Last updated
08/22/2024
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