Provider Demographics
NPI:1316834740
Name:RIOS, RANDY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:STEVEN
Last Name:RIOS
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 1:565 W 100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1265
Mailing Address - Country:US
Mailing Address - Phone:214-814-6398
Mailing Address - Fax:479-437-8049
Practice Address - Street 1:565 W 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1265
Practice Address - Country:US
Practice Address - Phone:214-814-6398
Practice Address - Fax:479-437-8049
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20034948363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical