1235385832 NPI number — DR. HOLLY LYNN SPRAKER-PERLMAN M.D.

Table of content: DR. HOLLY LYNN SPRAKER-PERLMAN M.D. (NPI 1235385832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235385832 NPI number — DR. HOLLY LYNN SPRAKER-PERLMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRAKER-PERLMAN
Provider First Name:
HOLLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPRAKER
Provider Other First Name:
HOLLY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235385832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84141-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-213-3900
Provider Business Mailing Address Fax Number:
801-662-4707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MARIO CAPECCHI DR
Provider Second Line Business Practice Location Address:
4TH FLOOR ONCOLOGY SUITE
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-662-4700
Provider Business Practice Location Address Fax Number:
801-662-4707
Provider Enumeration Date:
08/14/2008

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: 2080H0002X , with the licence number:  7598308-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0207X , with the licence number: 7598308-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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