Provider Demographics
NPI:1760549927
Name:AMBER, INA JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:JUDITH
Last Name:AMBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 S 1100 E STE 310
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:801-328-1260
Mailing Address - Fax:801-350-4361
Practice Address - Street 1:24 S 1100 E STE 310
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-328-1260
Practice Address - Fax:801-350-4361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171790-1205282N00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057369OtherMEDICARE ID
UTC63838Medicare UPIN