Healthcare Provider Details

I. General information

NPI: 1679525901
Provider Name (Legal Business Name): NORTH DAVIS ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W ANTELOPE DR
LAYTON UT
84041-1120
US

IV. Provider business mailing address

PO BOX 3810
SALT LAKE CITY UT
84110-3810
US

V. Phone/Fax

Practice location:
  • Phone: 801-807-1000
  • Fax:
Mailing address:
  • Phone: 801-432-2600
  • Fax: 770-701-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAY RICHARDSON
Title or Position: MANAGING EMPLOYEE/PRESIDENT
Credential: DO
Phone: 801-432-2600