Healthcare Provider Details

I. General information

NPI: 1336900349
Provider Name (Legal Business Name): KEIRON SAUER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

1873 W TRAVERSE PKWY STE E
LEHI UT
84048-5993
US

V. Phone/Fax

Practice location:
  • Phone: 801-215-9509
  • Fax:
Mailing address:
  • Phone: 801-215-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2026-0075
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: