Healthcare Provider Details

I. General information

NPI: 1609002872
Provider Name (Legal Business Name): GASMAN ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 WASHINGTON BLVD
OGDEN UT
84403
US

IV. Provider business mailing address

PO BOX 837
OGDEN UT
84402-0837
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4470
  • Fax:
Mailing address:
  • Phone: 801-392-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1951434406
License Number StateUT

VIII. Authorized Official

Name: MR. SPENCER J COMBE II
Title or Position: OWNER
Credential: CRNA
Phone: 801-476-8638