Basic Information
| Provider Information | |||||||||
| NPI: | 1548276637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2975 EXECUTIVE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840439642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019901911 | ||||||||
| FaxNumber: | 8019901912 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 HARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019939582 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207L00000X | 149879-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2090168 | 01 | UT | UNITED HEALTHCARE | OTHER | 8597445 | 01 | UT | WORKERS COMP. FUND | OTHER | 107005076101 | 01 | UT | IHC | OTHER | 53225 | 01 | UT | HEALTHY U | OTHER | 870545614AL1 | 01 | UT | EDUCATORS MUTUAL | OTHER | 35322 | 01 | UT | DESERET MUTUAL | OTHER | 1502954 | 01 | UT | UMWA | OTHER | PRA02496 | 01 | UT | MOLINA | OTHER | 37772 | 01 | UT | PEHP | OTHER | QM0000075886 | 01 | UT | ALTIUS | OTHER |