Healthcare Provider Details

I. General information

NPI: 1184898140
Provider Name (Legal Business Name): LAYFE ROBERT ANTHONY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S 300 W SUITE A
SALT LAKE CITY UT
84115-2398
US

IV. Provider business mailing address

1303 WASATCH DR
SALT LAKE CITY UT
84108-2441
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-5504
  • Fax:
Mailing address:
  • Phone: 801-859-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2767441205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: