Healthcare Provider Details

I. General information

NPI: 1548296312
Provider Name (Legal Business Name): ROBERT ROSS HIGHTOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E 5900 S STE A112
MURRAY UT
84107-7256
US

IV. Provider business mailing address

164 E 5900 S STE A112
MURRAY UT
84107-7256
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-2673
  • Fax: 801-269-9894
Mailing address:
  • Phone: 801-262-2673
  • Fax: 801-269-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156244-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: