Basic Information
| Provider Information | |||||||||
| NPI: | 1073753984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEMMILL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | HOLT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 EAST ST. GEORGE BLVD | ||||||||
| Address2: | RED ROCK CANYON SCHOOL | ||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847706210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356736111 | ||||||||
| FaxNumber: | 4356730994 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 EAST ST. GEORGE BLVD | ||||||||
| Address2: | RED ROCK CANYON SCHOOL | ||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847706210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356736111 | ||||||||
| FaxNumber: | 4356730994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 116727-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.