Provider Demographics
NPI:1316790108
Name:CLEGG, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:CLEGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 W REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9245
Mailing Address - Country:US
Mailing Address - Phone:619-981-6219
Mailing Address - Fax:
Practice Address - Street 1:4416 W REDWOOD DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-9245
Practice Address - Country:US
Practice Address - Phone:619-981-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program