Provider Demographics
NPI:1285680215
Name:HIEMSTRA, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:HIEMSTRA
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 1:3286 DANISH HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5758
Mailing Address - Country:US
Mailing Address - Phone:801-942-1741
Mailing Address - Fax:
Practice Address - Street 1:3286 DANISH HILLS CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5758
Practice Address - Country:US
Practice Address - Phone:801-942-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27113207P00000X
UT97-333085-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine