Malcolm S Allen III, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Orem, UT

NPI 1992809529 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1992809529
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
213871-4406 (UT)
Practice address
750 W 800 N
Orem, UT 84057-3660
Phone
(800) 748-4868
Fax
(801) 733-5618
NPI assigned
Sep 12, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
1491CAMDMental Health Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 213871-4406 UT Yes

Addresses

Primary practice location

750 W 800 N
Orem, UT 84057-3660

Mailing address

46 N 960 E
American Fork, UT 84003-2936
Phone (801) 756-9919

Other identifiers

IdentifierTypeStateIssuer
107007300107OtherUTIHC
870525882AL2OtherUTEDUCATORS MUTUAL
PRA07051OtherUTMOLINA
75949OtherUTPEHP
190382600OtherUTUS DEPT OF LABOR
QM0000076595OtherUTALTIUS
011517OtherUTHEALTHY U

Other providers in Orem, UT

All providers in Orem, UT · Certified Registered Nurse Anesthetist in Utah

Sources for this page

Verify at the official NPI Registry.