Healthcare Provider Details

I. General information

NPI: 1912974528
Provider Name (Legal Business Name): RODNEY J MUSSELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S SUITE 101
SOUTH JORDAN UT
84095-3211
US

IV. Provider business mailing address

3556 W 9800 S SUITE 101
SOUTH JORDAN UT
84095-3211
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax:
Mailing address:
  • Phone: 801-567-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01054627A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7999692-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: