Individual
MR. CARSON MICHAEL CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5740 CRESTWOOD DR, OGDEN, UT 84405-4869
(801) 475-3010
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05928
NC
363A00000X
Physician Assistant
Primary
12262766-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072981437
—
UT
Enumeration date
09/02/2015
Last updated
05/07/2021
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