Healthcare Provider Details

I. General information

NPI: 1053494393
Provider Name (Legal Business Name): ROBERT WILLIAM ENGELEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S. 1100 E. SUITE 303
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

82 S. 1100 E. SUITE 303
SALT LAKE CITY UT
84102
US

V. Phone/Fax

Practice location:
  • Phone: 843-794-6704
  • Fax:
Mailing address:
  • Phone: 910-465-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: