Healthcare Provider Details

I. General information

NPI: 1548304025
Provider Name (Legal Business Name): RICHARD O CLUFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N ANESTHESIA DEPT
OREM UT
84057-3660
US

IV. Provider business mailing address

1954 FORT UNION BLVD SUITE 101
SALT LAKE CITY UT
84121-6800
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6000
  • Fax:
Mailing address:
  • Phone: 801-993-9581
  • Fax: 801-733-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number264714-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-677
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: