Provider Demographics
NPI:1619959319
Name:FRUIN, CLAUDIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:J
Last Name:FRUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:M
Other - Last Name:JERIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 N. MEDICAL DR.
Mailing Address - Street 2:PO BOX 144610
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113
Mailing Address - Country:US
Mailing Address - Phone:801-584-8271
Mailing Address - Fax:801-584-8488
Practice Address - Street 1:44 N. MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1105
Practice Address - Country:US
Practice Address - Phone:801-584-8271
Practice Address - Fax:801-584-8488
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181369-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics