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General NPI Number Information
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NPI Number | 1457283541
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Entity Type | Individual
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Provider Name | THEODORE GERUN
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Gender | Male
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 3784 W VALLEY VIEW DR
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City | CEDAR HILLS
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State | UT
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Zip | 84062-8085
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Country | US
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Telephone | 801-407-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 222 S RIVER BEND CT
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City | LEHI
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State | UT
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Zip | 84043-4962
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Country | US
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Telephone | 801-380-3718
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | F26-159998
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License Number State | UT
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