=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285959502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA KATHERINE EYRE ERMARTH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2010
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 MARIO CAPECCHI
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-213-3599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 MARIO CAPECCHI
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-213-3599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number | 8141010-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------