Healthcare Provider Details

I. General information

NPI: 1659300044
Provider Name (Legal Business Name): ROBERT ZARAY TASHJIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 WAKARA WAY
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

PO BOX 58108
SALT LAKE CITY UT
84158-0108
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3998
  • Fax:
Mailing address:
  • Phone: 801-581-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number6209402-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6209402-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: