Healthcare Provider Details

I. General information

NPI: 1972531119
Provider Name (Legal Business Name): MELVIN RAUN CHILD P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 500 N
FILLMORE UT
84631-3514
US

IV. Provider business mailing address

PO BOX 842
FILLMORE UT
84631-0842
US

V. Phone/Fax

Practice location:
  • Phone: 435-979-2487
  • Fax:
Mailing address:
  • Phone: 435-979-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number106923-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: