Healthcare Provider Details

I. General information

NPI: 1043218464
Provider Name (Legal Business Name): SHARI LYN ROWLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 MANTI DR
DRAPER UT
84020-5120
US

IV. Provider business mailing address

1100 TERRALAGO WAY
KISSIMMEE FL
34746-2918
US

V. Phone/Fax

Practice location:
  • Phone: 801-545-0818
  • Fax:
Mailing address:
  • Phone: 801-545-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number120698
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number49032071205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00207996
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerRAIL ROAD
# 2
IdentifierD4150
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 3
Identifier49032078914001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBLUE CROSS BLUE SHIELD
# 4
Identifier013212200
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: