Provider Demographics
NPI:1275595985
Name:NIEMANN, BOBBY (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:NIEMANN
Suffix:
Gender:M
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:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:
Practice Address - Street 1:2891 E MALL DRIVE
Practice Address - Street 2:STE 101
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8479
Practice Address - Country:US
Practice Address - Phone:435-619-8632
Practice Address - Fax:435-619-8633
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12361745-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P6819OtherBCBS
TX124988013Medicaid
TX124988009Medicaid
TX297088YKRCMedicare PIN
TX8L16069Medicare PIN
TX124988009Medicaid