is a Vascular Surgery in Provo, Utah. practices all healthcare services and medical treatments related to Vascular Surgery. The NPI Number for is 1619134475. The last update date is .
's current location address is 395 W Cougar Blvd Ste 503, Provo, Utah. You can contact this provider via phone number 8013749100 and fax number 8013749117. The mailing address for is 395 W Cougar Blvd Ste 503, Provo, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 395 W Cougar Blvd Ste 503, Provo, Utah |
| Phone Number | 8013749100 |
| Fax Number | 8013749117 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1619134475 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 395 W Cougar Blvd Ste 503 |
|---|---|
| City | Provo |
| State | Utah (UT) |
| Post Code | 846043323 |
| Phone Number | 8013749100 |
| Fax Number | 8013749117 |
Provider's Primary Taxonomy Detail
| Speciality | Vascular Surgery |
|---|---|
| Taxonomy | 2086S0129X |
| Licence No | LT18891 |
|
Definition: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
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