Provider Demographics
NPI:1881097947
Name:VIOLLET, LOUIS MARIE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MARIE
Last Name:VIOLLET
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:MARIE
Other - Last Name:VIOLLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1038 E NORTHBONNEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4003
Mailing Address - Country:US
Mailing Address - Phone:801-541-2077
Mailing Address - Fax:
Practice Address - Street 1:295 S CHIPETA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1287
Practice Address - Country:US
Practice Address - Phone:801-585-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10118502-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10118502-1205OtherUTAH MEDICAL LICENSE