Healthcare Provider Details

I. General information

NPI: 1366782567
Provider Name (Legal Business Name): ANDREW ROBERT ROBINSON D O LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S STE 100
SOUTH JORDAN UT
84095-4713
US

IV. Provider business mailing address

1868 W 9800 S STE 100
SOUTH JORDAN UT
84095-4713
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-8848
  • Fax: 801-433-5734
Mailing address:
  • Phone: 801-285-8848
  • Fax: 801-433-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12754
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9036325-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: