Provider Demographics
NPI:1922377043
Name:SOUTHERN UTAH NEUROPSYCHIATRY
Entity Type:Organization
Organization Name:SOUTHERN UTAH NEUROPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-634-0622
Mailing Address - Street 1:577 EAST TABERNACLE
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2944
Mailing Address - Country:US
Mailing Address - Phone:435-634-0622
Mailing Address - Fax:435-674-7621
Practice Address - Street 1:577 EAST TABERNACLE
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2944
Practice Address - Country:US
Practice Address - Phone:435-634-0622
Practice Address - Fax:435-674-7621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN UTAH NEUROPSYCHIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT000082152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty