Provider Demographics
NPI:1033244207
Name:NAKKEN, ROBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:NAKKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7792
Mailing Address - Country:US
Mailing Address - Phone:435-586-6962
Mailing Address - Fax:435-867-1663
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:SUITE 150
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7792
Practice Address - Country:US
Practice Address - Phone:435-586-6962
Practice Address - Fax:435-867-1663
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362925-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG14699Medicare UPIN
UT000012074Medicare ID - Type Unspecified