MEDICARE: REX A OUTTRIM 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	207RC0000X	Cardiovascular Disease Physician	5006181205	UT

General Provider Information

NPI Number	:	1558355313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REX A OUTTRIM MD

Provider Business Mailing Address
First Line	:	5121 S COTTONWOOD ST
Second Line	:	SUITE 520
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:	801-507-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3723 W 12600 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7295
Country	:	US
Telephone Number	:	801-285-4590
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/18/2014

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