Organization
SANDMAN PHYSICIAN SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD L GLINES MD (PRESIDENT)
(801) 209-7348
Entity
Organization
Contact information
Practice address
637 SEGO LILY CIR, NORTH SALT LAKE, UT 84054-3355
(801) 209-7348
Mailing address
637 SEGO LILY CIR, NORTH SALT LAKE, UT 84054-3355
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
75964441205
UT
207LH0002X
Hospice and Palliative Medicine (Anesthesiology) Physician
75964441205
UT
207LP2900X
Pain Medicine (Anesthesiology) Physician
75964441205
UT
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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