MEDICARE: DR. RICHARD B GREMILLION MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	1882521205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660002498	OTHER	UT	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1205820693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD B GREMILLION MD

Provider Business Mailing Address
First Line	:	2965 W 3500 S STE 100
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 E MURRAY HOLLADAY RD STE 207
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-5093
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/18/2024

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