Healthcare Provider Details

I. General information

NPI: 1033145339
Provider Name (Legal Business Name): JAMIE LYNN REBMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD RD SUITE 610
MURRAY UT
84107
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3630
  • Fax: 801-507-3630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42497
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number7610500-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: