Provider Demographics
NPI:1659319531
Name:LLOYD, LAYNE (MD)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:
Last Name:LLOYD
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 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:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:1225 FORT UNION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:801-233-4410
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807102300Medicaid
UT000059721Medicare PIN
I26510Medicare UPIN
UT000059723Medicare PIN
UT000059720Medicare PIN
ID807102300Medicaid
UT000059722Medicare PIN
UT000059732Medicare PIN
UT00005931Medicare PIN