Healthcare Provider Details

I. General information

NPI: 1831755669
Provider Name (Legal Business Name): MATTHEW RYAN MCNAUGHTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 07/06/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403-3195
US

IV. Provider business mailing address

4010 ADAMS AVENUE #B112
OGDEN UT
84403
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2800
  • Fax:
Mailing address:
  • Phone: 580-554-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34915
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13387308-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: