Healthcare Provider Details

I. General information

NPI: 1326138934
Provider Name (Legal Business Name): RICHARD C. KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 3490
OGDEN UT
84403-3271
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2650
  • Fax: 801-475-1621
Mailing address:
  • Phone: 801-387-2650
  • Fax: 801-475-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number186076-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number186076-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: