Provider Demographics
NPI:1720193956
Name:GASSMAN, JAY H (CRNA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:GASSMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4571
Mailing Address - Country:US
Mailing Address - Phone:801-796-3546
Mailing Address - Fax:
Practice Address - Street 1:300 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4218
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT199347-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2000575OtherUNITED HEALTHCARE
UTPRA02133OtherMOLINA
UT7561OtherHEALTHY U
UT107008681104OtherIHC
UTQM0000076612OtherALTIUS
UT76565OtherPEHP
UT343841OtherDESERET MUTUAL
UT76565OtherPEHP
UTS38308Medicare UPIN