Provider Demographics
NPI:1144290479
Name:TOPHAM, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:TOPHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4203
Mailing Address - Country:US
Mailing Address - Phone:801-272-4408
Mailing Address - Fax:801-272-4441
Practice Address - Street 1:1775 E 4500 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4203
Practice Address - Country:US
Practice Address - Phone:801-272-4408
Practice Address - Fax:801-272-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2770041205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012071Medicare PIN
UTG37979Medicare UPIN