Provider Demographics
NPI:1487622908
Name:PRAMANN, ROBERT FREDERICK JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FREDERICK
Last Name:PRAMANN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:PRAMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:404 E 4500 S STE B22
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2776
Mailing Address - Country:US
Mailing Address - Phone:801-268-1564
Mailing Address - Fax:801-268-1565
Practice Address - Street 1:404 E 4500 S STE B22
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2776
Practice Address - Country:US
Practice Address - Phone:801-268-1564
Practice Address - Fax:801-268-1565
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114495-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
240843OtherVALUE OPTIONS
UT870476172-003OtherVALLEY MH #
000004824OtherNORIDIAN MEDICARE
UT870476172PR1OtherEDUCATORS #
UT107009345101OtherIHC HEALTH PLANS #
UT19291OtherPEHP #
UT870476172DOtherFIRST HEALTH #
UTTPRA11035OtherMOLINA HEALTHCARE #
UTR34378Medicare UPIN