MEDICARE: MR. ROBERT EPPENS

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	231H00000X	Audiologist	270231	UT

General Provider Information

NPI Number	:	1760476022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EPPENS

Provider Business Mailing Address
First Line	:	6025 BREEZE CIR
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-5001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7238 6TH ST
Second Line	:	75TH AEROSPACE MEDICINE SQUADRON/SGPMA
City	:	HILL AFB
State	:	UT
Zip	:	84056-5213
Country	:	US
Telephone Number	:	801-777-1166
Fax Number	:

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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