Provider Demographics
NPI:1407074461
Name:CLOWARD, RICHARD DIX (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DIX
Last Name:CLOWARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 4400
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3290
Mailing Address - Country:US
Mailing Address - Phone:801-387-4550
Mailing Address - Fax:801-387-4565
Practice Address - Street 1:4403 HARRISON BLVD STE 4400
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3290
Practice Address - Country:US
Practice Address - Phone:801-387-4550
Practice Address - Fax:801-387-4565
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4960478-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical