MEDICARE: JOHN RALPH PATER

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	231H00000X	Audiologist	1039154101	UT

General Provider Information

NPI Number	:	1427223668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RALPH PATER

Provider Business Mailing Address
First Line	:	2964 WEST 4700 SOUTH
Second Line	:	SUITE #116
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84129
Country	:	US
Telephone Number	:	801-417-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2964 W 4700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-2557
Country	:	US
Telephone Number	:	801-417-9696
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	01/31/2013

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