MEDICARE: G LYNN RASMUSSEN MD PC

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	1641831205	UT

General Provider Information

NPI Number	:	1548410608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G LYNN RASMUSSEN MD PC

Provider Business Mailing Address
First Line	:	5848 FASHION BLVD STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6121
Country	:	US
Telephone Number	:	801-314-4002
Fax Number	:	801-314-4015

Provider Business Practice Location Address
First Line	:	5848 FASHION BLVD STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6121
Country	:	US
Telephone Number	:	801-314-4002
Fax Number	:	801-314-4015

Authorized Official
Title or Position	:	PRESIDENT
Name	:	G LYNN RASMUSSEN
Credential	:	MD
Telephone Number	:	801-314-4002

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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