Provider Demographics
NPI:1770512238
Name:CHRISTENSEN, SCOTT K (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:CHRISTENSEN
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 58202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-0202
Mailing Address - Country:US
Mailing Address - Phone:801-583-3395
Mailing Address - Fax:801-583-2175
Practice Address - Street 1:3580 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8812
Practice Address - Country:US
Practice Address - Phone:801-561-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT781622081205207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT353638700OtherUS DEPT LABOR
UTQM0000054602OtherALTIUS
UT870484603CHROtherEDUCATOR MUTUAL
UT050087245OtherMEDICARE A
UT87042OtherUPRR
UT5177981OtherCCN
UTQM0000054602OtherALTIUS
UT870484603CHROtherEDUCATOR MUTUAL