Provider Demographics
NPI:1528008588
Name:RASMUSSEN, R RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:RICHARD
Last Name:RASMUSSEN
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 1:3550 N UNIVERSITY AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-374-9625
Mailing Address - Fax:801-374-9690
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:STE 302
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-852-3461
Practice Address - Fax:801-852-3459
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2830291205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87051626Y009Medicaid
UT005516603Medicare ID - Type Unspecified
UT87051626Y009Medicaid