Basic Information
| Provider Information | |||||||||
| NPI: | 1922046911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZANOLLI | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1747 | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840591747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668987136 | ||||||||
| FaxNumber: | 6169759827 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 W 800 N | ||||||||
| Address2: | ER DEPARTMENT | ||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017146570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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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 | 207PE0004X | 164ZZZ1205 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 107006395104 | 01 | UT | SELECT HEALTH | OTHER | 06226 | 05 | UT | MEDICAID | P00189727 | 01 | RR MEDICARE | OTHER | 81793 | 01 | UT | PEHP | OTHER | 313376 | 01 | UT | DESERET MUTUAL | OTHER |