Individual
ROMAN A SHINGAREV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3702 S STATE ST STE 107, SOUTH SALT LAKE, UT 84115-5096
(801) 288-2634
(801) 288-1186
Mailing address
3702 S STATE ST STE 107, SOUTH SALT LAKE, UT 84115-5096
(801) 288-2634
(801) 288-1186
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
13466615-1205
UT
207RN0300X
Nephrology Physician
27857
AL
207RN0300X
Nephrology Physician
35.140576
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051119633
BCBS
AL
01
—
051119646
BCBS
AL
01
—
051119647
BCBS
AL
05
—
06250501
—
MS
05
—
130856
—
AL
05
—
130858
—
AL
05
—
130859
—
AL
05
—
1457564601
—
UT
01
—
Z21075
VIVA
AL
Enumeration date
05/07/2007
Last updated
05/03/2024
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