Provider Demographics
NPI:1912500745
Name:PUGH, ROBERT DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:PUGH
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 1:775 E 200 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4953
Mailing Address - Country:US
Mailing Address - Phone:801-633-5416
Mailing Address - Fax:
Practice Address - Street 1:775 E 200 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4953
Practice Address - Country:US
Practice Address - Phone:801-633-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5494787-3102163W00000X
NC310189163WC0200X
NC6543367500000X
UT0000000-0000367500000X
OR202211571CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNONE