Healthcare Provider Details

I. General information

NPI: 1417301912
Provider Name (Legal Business Name): SARAH E. GERMAINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 NORTH MEDICAL DRIVE EAST
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

175 NORTH MEDICAL DRIVE EAST
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-7007
  • Fax:
Mailing address:
  • Phone: 801-382-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number7205810
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12762245-1204
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO216918
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: