Healthcare Provider Details

I. General information

NPI: 1114229960
Provider Name (Legal Business Name): ROBERT JAY THOMAS JR PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E 2100 S STE 250
SALT LAKE CITY UT
84106-5318
US

IV. Provider business mailing address

675 E 2100 S STE 250
SALT LAKE CITY UT
84106-5318
US

V. Phone/Fax

Practice location:
  • Phone: 801-867-8550
  • Fax: 801-484-3862
Mailing address:
  • Phone: 801-867-8550
  • Fax: 801-484-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateUT

VIII. Authorized Official

Name: ROBERT JAY THOMAS JR PHD PC
Title or Position: OWNER
Credential: PHD PC
Phone: 801-867-8550