Provider Demographics
NPI:1528160769
Name:KILLPACK, CLAYTON DENNING (MD)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:DENNING
Last Name:KILLPACK
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 1:2975 EXECUTIVE PKWY
Mailing Address - Street 2:200
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-9642
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:9660 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3762
Practice Address - Country:US
Practice Address - Phone:801-993-9582
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4979083-1205207L00000X
MT115334207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107027653101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT77516OtherPEHP
UT826031OtherHEALTHY U
UT49790831200001OtherBCBS
ID806874300Medicaid
UT850808OtherDESERET MUTUAL
UT870545614KILOtherEDUCATORS MUTUAL
NV100503296Medicaid
WY119676600Medicaid
UT1502954OtherUMWA
AZ859647Medicaid
UTQM0000075886OtherALTIUS
UTTPRA09320OtherMOLINA