Healthcare Provider Details

I. General information

NPI: 1922163534
Provider Name (Legal Business Name): ROBERT S TERASHIMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 SOUTH 2700 WEST
WEST JORDAN UT
84088
US

IV. Provider business mailing address

8925 SOUTH 2700 WEST
WEST JORDAN UT
84088
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-6200
  • Fax: 801-566-7993
Mailing address:
  • Phone: 801-566-6200
  • Fax: 801-566-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1609951205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1609958905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: