Provider Demographics
NPI:1134470347
Name:LYNN R NIMER, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LYNN R NIMER, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-251-2150
Mailing Address - Street 1:1380 E MEDICAL CENTER DR STE 3500
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2138
Mailing Address - Country:US
Mailing Address - Phone:435-251-2150
Mailing Address - Fax:435-251-2151
Practice Address - Street 1:1380 EAST MEDICAL CENTER STE 3500
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-2150
Practice Address - Fax:435-251-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1787801205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000011708OtherMEDICARE
UTF81970Medicare UPIN