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General NPI Number Information
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NPI Number | 1689442501
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Entity Type | Individual
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Provider Name | SAMUEL L ROBINSON
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Gender | Male
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 661 W SOUTH JORDAN PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8524
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Country | US
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Telephone | 801-302-2690
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Fax | 801-302-2693
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Provider Business Mailing Address
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Address Line | 661 W SOUTH JORDAN PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8524
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Country | US
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Telephone | 801-302-2690
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Fax | 801-302-2693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 14208626-1206
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License Number State | UT
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