Provider Demographics
NPI:1285971697
Name:ROBERT W LATER MD PC
Entity type:Organization
Organization Name:ROBERT W LATER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-571-0009
Mailing Address - Street 1:9600 S 1300 E STE 302
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3754
Mailing Address - Country:US
Mailing Address - Phone:801-571-0009
Mailing Address - Fax:
Practice Address - Street 1:9600 S 1300 E SUITE 302
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:801-571-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1696358905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07501Medicare UPIN