Individual
DR. ROBERT B BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 E 3900 S STE 5000, SALT LAKE CITY, UT 84124-1275
(801) 262-8486
(801) 261-7429
Mailing address
PO BOX 100253, ATLANTA, GA 30384-0253
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
180189-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09941
—
UT
Enumeration date
08/19/2005
Last updated
02/09/2022
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