Provider Demographics
NPI:1669567376
Name:LATER, ROBERT WENDALL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WENDALL
Last Name:LATER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3602
Mailing Address - Country:US
Mailing Address - Phone:801-965-3600
Mailing Address - Fax:
Practice Address - Street 1:9600 S 1300 E STE 220
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3783
Practice Address - Country:US
Practice Address - Phone:801-571-0009
Practice Address - Fax:801-576-1085
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1696358905207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000002174Medicare ID - Type Unspecified
UTDO7501Medicare UPIN