Provider Demographics
NPI:1457688590
Name:RASBAND, JAMES EDWIN (M D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWIN
Last Name:RASBAND
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5267
Mailing Address - Country:US
Mailing Address - Phone:801-224-7903
Mailing Address - Fax:
Practice Address - Street 1:3757 PEBBLE LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5267
Practice Address - Country:US
Practice Address - Phone:801-224-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153382-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology