Basic Information
| Provider Information | |||||||||
| NPI: | 1134106784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYNDERGAARD | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 W 500 S STE 9 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357256300 | ||||||||
| FaxNumber: | 4357256325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 W 500 S STE 9 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357256300 | ||||||||
| FaxNumber: | 4357256325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2005 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 6820891 | UT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 830024100 | 05 | MN | MEDICAID |