Basic Information
| Provider Information | |||||||||
| NPI: | 1679525901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH DAVIS ANESTHESIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3810 | ||||||||
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| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841103810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014322600 | ||||||||
| FaxNumber: | 7707016674 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W ANTELOPE DR | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018071000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING EMPLOYEE/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8014322600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.