Provider Demographics
NPI:1346566171
Name:SOMERS, ALEXIS MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MICHELE
Last Name:SOMERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MICHELE
Other - Last Name:MACNEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-357-7930
Mailing Address - Fax:801-357-7014
Practice Address - Street 1:475 W 940 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3301
Practice Address - Country:US
Practice Address - Phone:801-357-7930
Practice Address - Fax:801-357-7014
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT8046550-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program