Provider Demographics
NPI:1114161262
Name:ROYER, PAMELA AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:AUSTIN
Last Name:ROYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1718
Mailing Address - Country:US
Mailing Address - Phone:503-320-6884
Mailing Address - Fax:
Practice Address - Street 1:5063 S COTTONWOOD ST
Practice Address - Street 2:120
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6766
Practice Address - Country:US
Practice Address - Phone:801-566-5494
Practice Address - Fax:801-537-7238
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT8602227-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program