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General NPI Number Information
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NPI Number | 1760814834
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Entity Type | Organization
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Legal Business Name | SANDMAN PHYSICIAN SERVICES PC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 637 SEGO LILY CIR
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-3355
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Country | US
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Telephone | 801-209-7348
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Fax |
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Provider Business Mailing Address
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Address Line | 637 SEGO LILY CIR
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-3355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD L GLINES
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Credential | MD
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Telephone | 801-209-7348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Anesthesiology) Physician
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License Number | 75964441205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 75964441205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 75964441205
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License Number State | UT
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