Provider Demographics
NPI:1689039976
Name:THUESON, ROSS KELLEY (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:KELLEY
Last Name:THUESON
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 1:62 E 3450 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5734
Mailing Address - Country:US
Mailing Address - Phone:801-360-2909
Mailing Address - Fax:
Practice Address - Street 1:62 E. 3450 N.
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5734
Practice Address - Country:US
Practice Address - Phone:801-360-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17508-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT176508-1205OtherMEDICAL LICENSE