1326046160 NPI number — ROBIN OCKEY MD

Table of content: ROBIN OCKEY MD (NPI 1326046160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326046160 NPI number — ROBIN OCKEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCKEY
Provider First Name:
ROBIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326046160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
283 E 930 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84058-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-225-6246
Provider Business Mailing Address Fax Number:
801-225-1525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1134 N 500 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-357-8310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  5239675-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42396751203001 . This is a "BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 783689 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107016518103 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1326046160 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870284448ZRB . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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