MEDICARE: DR. ROBERT C HIEMSTRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G27113	CA
2	207P00000X	Emergency Medicine Physician	97-333085-1205	UT

General Provider Information

NPI Number	:	1285680215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C HIEMSTRA MD

Provider Business Mailing Address
First Line	:	3286 DANISH HILLS CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5758
Country	:	US
Telephone Number	:	801-942-1741
Fax Number	:

Provider Business Practice Location Address
First Line	:	3286 DANISH HILLS CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5758
Country	:	US
Telephone Number	:	801-942-1741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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