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General NPI Number Information
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NPI Number | 1013950286
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Entity Type | Organization
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Legal Business Name | LAYTON AMBULATORY ANESTHESIA, INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 1544 W ANTELOPE DRIVE
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City | LAYTON
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State | UT
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Zip | 84041-1146
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Country | US
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Telephone | 801-773-3339
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Fax | 801-773-6727
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Provider Business Mailing Address
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Address Line | P.O. BOX 3810
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City | SALT LAKE CITY
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State | UT
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Zip | 84110-3810
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Country | US
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Telephone | 801-727-2069
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Fax | 678-285-6776
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Authorized Official
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Title or Position | GROUP PRESIDENT
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Name | BRYAN HOLBROOK
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Credential | MD
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Telephone | 801-499-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | UT
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