Organization
MT. TIMPANOGAS FERTILITY & ENDOCRINOLOGY, PLLC
Active
Organization
MT. TIMPANOGAS FERTILITY & ENDOCRINOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANSEL RAYNER (OWNER)
(801) 938-9627
Entity
Organization
Contact information
Practice address
880 E 9400 S STE 112, SANDY, UT 84094-4134
(801) 938-9627
(801) 666-6915
Mailing address
880 E 9400 S STE 112, SANDY, UT 84094-4134
(801) 938-9627
(801) 666-6915
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
6814504-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356319842
INDIVIDUAL NPI #
UT
05
—
1356319842
—
UT
Enumeration date
07/07/2015
Last updated
11/03/2015
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