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General NPI Number Information
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NPI Number | 1174984058
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Entity Type | Individual
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Provider Name | LANE CLAYTON THAUT D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1743 S SIDEWINDER DRIVE UNIT 114
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City | PARK CITY
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State | UT
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Zip | 84060
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Country | US
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Telephone | 307-840-9834
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Fax |
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Provider Business Mailing Address
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Address Line | 1743 SIDEWINDER DR UNIT 114
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City | PARK CITY
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State | UT
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Zip | 84060-7322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 17163
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | DOS-1915
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DOS-1915
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License Number State | HI
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R4911
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License Number State | TX
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