Healthcare Provider Details

I. General information

NPI: 1235385832
Provider Name (Legal Business Name): HOLLY LYNN SPRAKER-PERLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY LYNN SPRAKER MD

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR 4TH FLOOR ONCOLOGY SUITE
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 413021
SALT LAKE CITY UT
84141-3021
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-4700
  • Fax: 801-662-4707
Mailing address:
  • Phone: 801-213-3900
  • Fax: 801-662-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number7598308-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number7598308-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: