Provider Demographics
NPI:1235468471
Name:J BARRY ROBB MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:J BARRY ROBB MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-2531
Mailing Address - Street 1:1220 E 3900 S STE 3F
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1326
Mailing Address - Country:US
Mailing Address - Phone:801-268-2531
Mailing Address - Fax:801-263-2922
Practice Address - Street 1:1220 E 3900 S STE 3F
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1326
Practice Address - Country:US
Practice Address - Phone:801-268-2531
Practice Address - Fax:801-263-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528524146000Medicaid
UT528524146000Medicaid