Individual
JAMES GERALD CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1433 N 1075 W STE 104, FARMINGTON, UT 84025-2746
(801) 298-1300
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
5617957-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
Primary
5617957-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107031591105
SELECTHEALTH
UT
05
—
1750478707
—
UT
01
—
56179571210001
BCBSUT
UT
01
—
56179571211001
BCBSUT
UT
01
—
847597
DMBA
UT
01
—
P00808365
RR MEDICARE
UT
01
—
P00808370
RR MEDICARE
UT
Enumeration date
10/09/2006
Last updated
05/28/2021
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