Basic Information
| Provider Information | |||||||||
| NPI: | 1083685101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THEURER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 S 1025 E | ||||||||
| Address2: | |||||||||
| City: | LINDON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840422134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013623151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1735 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846041010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013741818 | ||||||||
| FaxNumber: | 8013792959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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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 | 207W00000X | 983624541205 | UT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180041850 | 01 | UT | RAILROAD MEDICARE | OTHER | 5557665 | 01 | UT | AETNA | OTHER | 8064710002 | 01 | UT | CIGNA | OTHER | 87028357684604A001 | 01 | UT | PGBA | OTHER | 0800084 | 01 | UT | UNITED HEALTHCARE | OTHER | 87028357684604A001 | 01 | UT | TRICARE | OTHER | 870283576TH1 | 01 | UT | EMIA | OTHER | 345610 | 01 | UT | DMBA | OTHER | 1182764 | 01 | UT | AFFORDABLE | OTHER | 107008469102 | 01 | UT | SELECT HEALTH | OTHER |