Organization
PULMONARY INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET L GRANT (OFFICE MANAGER)
(801) 263-2482
Entity
Organization
Contact information
Practice address
1220 E 3900 S STE 2C, SALT LAKE CITY, UT 84124-1319
(801) 263-2482
(801) 263-2424
Mailing address
1220 E 3900 S STE 2C, SALT LAKE CITY, UT 84124-1319
(801) 263-2482
(801) 263-2424
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055221
PTAN
UT
01
—
2294
UNIV OF UTAH
—
01
—
DB6972
RAILROAD MEDICARE
—
Enumeration date
07/08/2006
Last updated
11/13/2012
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