Healthcare Provider Details

I. General information

NPI: 1245356559
Provider Name (Legal Business Name): EPHRAIM PAUL LLOYD ACA, BC HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 S MAIN ST #7
SALT LAKE CITY UT
84115-2036
US

IV. Provider business mailing address

1817 S MAIN ST #7
SALT LAKE CITY UT
84115-2036
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-5595
  • Fax:
Mailing address:
  • Phone: 801-485-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3094025-4601
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3094025-4601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: