Provider Demographics
NPI:1124679949
Name:ROBERT B TOPHAM
Entity type:Organization
Organization Name:ROBERT B TOPHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-272-4408
Mailing Address - Street 1:1775 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4257
Mailing Address - Country:US
Mailing Address - Phone:801-272-4408
Mailing Address - Fax:801-272-4441
Practice Address - Street 1:1775 E 4500 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4257
Practice Address - Country:US
Practice Address - Phone:801-272-4408
Practice Address - Fax:801-272-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144290479OtherINDIVIDUAL NPI