Healthcare Provider Details

I. General information

NPI: 1043375181
Provider Name (Legal Business Name): MY FAMILY DOCTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 E 12300 S SUITE 201
DRAPER UT
84020
US

IV. Provider business mailing address

877 E 12300 S SUITE 201
DRAPER UT
84020
US

V. Phone/Fax

Practice location:
  • Phone: 801-542-7111
  • Fax: 801-542-7112
Mailing address:
  • Phone: 801-542-7111
  • Fax: 801-542-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAYNE A HERMANSEN
Title or Position: OWNER
Credential: DO
Phone: 801-542-7111