| Doctor Name: | ROBERT A CHURCH |
| NPI Number: | 1023390531 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 8926321-0501 |
| Business Practice Address: | 440 Medical Dr Ste 2 Bountiful, UT - 840104943 |
| Business Phone Number: | 8012981160 |
| Business Fax Number: | 8012943299 |
| Mailing Address: | 440 Medical Dr, Ste 2 BOUNTIFUL |
| State: | UT |
| Postal Code: | 840104943 |
| Phone Number: | 8012981160 |
| Fax Number: | 8012943299 |
| NPI Enumeration Date: | 09/12/2011 |
| NPI Last Update Date: | 02/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 8926321-0501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |