Provider Demographics
NPI:1710995386
Name:KLATT, R STEVEN
Entity Type:Individual
Prefix:
First Name:R
Middle Name:STEVEN
Last Name:KLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SIDEWINDER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7492
Mailing Address - Country:US
Mailing Address - Phone:435-655-6600
Mailing Address - Fax:
Practice Address - Street 1:1820 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7492
Practice Address - Country:US
Practice Address - Phone:435-655-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284844-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000051402OtherALTIUS HEALTH PLANS
UT62500OtherPUBLIC EMPLOYEES HEALTH P
UT107012319101OtherSELECTHEALTH
UT62500OtherPUBLIC EMPLOYEES HEALTH P