Provider Demographics
NPI:1659616241
Name:ROCKY MOUNTAIN ALLERGY ASTHMA AND IMMUNOLOGY, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ALLERGY ASTHMA AND IMMUNOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-775-9800
Mailing Address - Street 1:1660 W ANTELOPE DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1156
Mailing Address - Country:US
Mailing Address - Phone:801-775-9800
Mailing Address - Fax:801-775-9806
Practice Address - Street 1:1660 W ANTELOPE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1156
Practice Address - Country:US
Practice Address - Phone:801-775-9800
Practice Address - Fax:801-775-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5864207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1346324761OtherJONES INDIVIDUAL NPI
UT1477555712OtherGOURLEY INDIVIDUAL NPI