Healthcare Provider Details

I. General information

NPI: 1205032877
Provider Name (Legal Business Name): RYAN B SPRINGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W ANTELOPE DR
LAYTON UT
84041-1142
US

IV. Provider business mailing address

1600 W ANTELOPE DR
LAYTON UT
84041-1142
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-5728
  • Fax:
Mailing address:
  • Phone: 801-807-7140
  • Fax: 801-807-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7939555-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: