Basic Information
| Provider Information | |||||||||
| NPI: | 1992809529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | MALCOLM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 N 960 E | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017569919 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 750 W 800 N | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007484868 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| 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 | 367500000X | 213871-4406 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 107007300107 | 01 | UT | IHC | OTHER | 870525882AL2 | 01 | UT | EDUCATORS MUTUAL | OTHER | PRA07051 | 01 | UT | MOLINA | OTHER | 75949 | 01 | UT | PEHP | OTHER | 190382600 | 01 | UT | US DEPT OF LABOR | OTHER | QM0000076595 | 01 | UT | ALTIUS | OTHER | 011517 | 01 | UT | HEALTHY U | OTHER |