Provider Demographics
NPI:1801155312
Name:WESTBROOK, ROBERT CALVIN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CALVIN
Last Name:WESTBROOK
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:
Mailing Address - Fax:
Practice Address - Street 1:1915 W 5950 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1454
Practice Address - Country:US
Practice Address - Phone:801-387-8100
Practice Address - Fax:801-387-8223
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10542452-1205207Q00000X
IN11016463A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000944393OtherBCBS
IN201112770Medicaid
IN000000944393OtherBCBS