Healthcare Provider Details

I. General information

NPI: 1003310426
Provider Name (Legal Business Name): RYAN NIMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MEDICAL DR
BOUNTIFUL UT
84010-4908
US

IV. Provider business mailing address

630 MEDICAL DR
BOUNTIFUL UT
84010-4908
US

V. Phone/Fax

Practice location:
  • Phone: 435-773-0112
  • Fax:
Mailing address:
  • Phone: 435-773-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13288648-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: