Provider Demographics
NPI:1083685101
Name:THEURER, JAMES G (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:THEURER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 S 1025 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2134
Mailing Address - Country:US
Mailing Address - Phone:801-362-3151
Mailing Address - Fax:
Practice Address - Street 1:1735 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1010
Practice Address - Country:US
Practice Address - Phone:801-374-1818
Practice Address - Fax:801-379-2959
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT983624541205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT180041850OtherRAILROAD MEDICARE
UT5557665OtherAETNA
UT8064710002OtherCIGNA
UT87028357684604A001OtherPGBA
UT0800084OtherUNITED HEALTHCARE
UT87028357684604A001OtherTRICARE
UT870283576TH1OtherEMIA
UT345610OtherDMBA
UT1182764OtherAFFORDABLE
UT107008469102OtherSELECT HEALTH
UT87028357684604A001OtherPGBA
UT005504404Medicare ID - Type Unspecified