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General NPI Number Information
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NPI Number | 1659616241
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN ALLERGY ASTHMA AND IMMUNOLOGY, LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 1660 W ANTELOPE DR SUITE 225
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City | LAYTON
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State | UT
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Zip | 84041-1156
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Country | US
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Telephone | 801-775-9800
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Fax | 801-775-9806
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Provider Business Mailing Address
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Address Line | 1660 W ANTELOPE DR SUITE 225
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City | LAYTON
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State | UT
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Zip | 84041-1156
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Country | US
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Telephone | 801-775-9800
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Fax | 801-775-9806
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DOUGLAS H JONES
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Credential | MD
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Telephone | 801-775-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 5864
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License Number State | UT
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