Healthcare Provider Details

I. General information

NPI: 1518949411
Provider Name (Legal Business Name): ROLFE P HORSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S 300 E #203
MURRAY UT
84107-5419
US

IV. Provider business mailing address

6040 S 300 E #203
MURRAY UT
84107-5419
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-2353
  • Fax: 801-266-2380
Mailing address:
  • Phone: 801-266-2353
  • Fax: 801-266-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1635571205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: