Provider Demographics
NPI:1063420651
Name:GEMMELL, LOIS JEANNE (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:JEANNE
Last Name:GEMMELL
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 1:455 E SOUTH TEMPLE
Mailing Address - Street 2:#202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111
Mailing Address - Country:US
Mailing Address - Phone:801-355-9951
Mailing Address - Fax:801-355-9968
Practice Address - Street 1:455 E SOUTH TEMPLE
Practice Address - Street 2:#202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111
Practice Address - Country:US
Practice Address - Phone:801-355-9951
Practice Address - Fax:801-355-9968
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1727811205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21257Medicare UPIN