Healthcare Provider Details

I. General information

NPI: 1225977507
Provider Name (Legal Business Name): RYAN SMUIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST STE 201
MIDWAY UT
84049-6817
US

IV. Provider business mailing address

5481 W ROSE SUMMIT DR
HERRIMAN UT
84096-3442
US

V. Phone/Fax

Practice location:
  • Phone: 435-654-2822
  • Fax:
Mailing address:
  • Phone: 435-621-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: