Healthcare Provider Details

I. General information

NPI: 1487622908
Provider Name (Legal Business Name): ROBERT FREDERICK PRAMANN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROB PRAMANN PHD

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E 4500 S STE B22
MURRAY UT
84107-2776
US

IV. Provider business mailing address

404 E 4500 S STE B22
MURRAY UT
84107-2776
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1564
  • Fax: 801-268-1565
Mailing address:
  • Phone: 801-268-1564
  • Fax: 801-268-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number114495-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: