Provider Demographics
NPI:1619048964
Name:RASMUSEN, CARL (MD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:RASMUSEN
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0639
Mailing Address - Country:US
Mailing Address - Phone:801-299-2165
Mailing Address - Fax:801-299-7811
Practice Address - Street 1:630 E MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-299-3783
Practice Address - Fax:801-299-6119
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18093912052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9670891208001Medicaid
5811705Medicare ID - Type Unspecified
E76950Medicare UPIN