Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 159564-1205 | UT |
N | 207PE0004X | Emergency Medical Services | 159564-1205 | UT |
NPI | 1184686768 |
---|---|
Provider Name | Dr. Lyman Val Rollins |
First Address | Salt Lake City, UT 84102-1907 |
Second Address | Ogden, UT 84405-6905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05386 | (05) | UT |
930085282 | RAILROAD (01) | UT |
D87745 | (02) | UT |