Healthcare Provider Details

I. General information

NPI: 1659616241
Provider Name (Legal Business Name): ROCKY MOUNTAIN ALLERGY ASTHMA AND IMMUNOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 E 5900 S STE 201
MURRAY UT
84107-5426
US

IV. Provider business mailing address

279 E 5900 S STE 201
MURRAY UT
84107-5426
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-6039
  • Fax: 949-864-3316
Mailing address:
  • Phone: 801-252-6039
  • Fax: 949-864-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number5864
License Number StateUT

VIII. Authorized Official

Name: DOUGLAS HARRY JONES
Title or Position: CEO
Credential:
Phone: 801-252-6039