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General NPI Number Information
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NPI Number | 1548410608
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Entity Type | Organization
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Legal Business Name | G LYNN RASMUSSEN MD PC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 5848 FASHION BLVD STE 110
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-6121
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Country | US
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Telephone | 801-314-4002
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Fax | 801-314-4015
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Provider Business Mailing Address
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Address Line | 5848 FASHION BLVD STE 110
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-6121
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Country | US
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Telephone | 801-314-4002
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Fax | 801-314-4015
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Authorized Official
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Title or Position | PRESIDENT
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Name | G LYNN RASMUSSEN
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Credential | MD
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Telephone | 801-314-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 1641831205
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License Number State | UT
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