Provider Demographics
NPI:1205820693
Name:GREMILLION, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:GREMILLION
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11333 S 1000 E
Mailing Address - Street 2:STE 100
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5429
Mailing Address - Country:US
Mailing Address - Phone:801-571-4100
Mailing Address - Fax:801-571-4125
Practice Address - Street 1:11333 S 1000 E
Practice Address - Street 2:STE 100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5429
Practice Address - Country:US
Practice Address - Phone:801-571-4100
Practice Address - Fax:801-571-4125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT1882521205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G66398Medicare UPIN