Individual
BRYAN A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9844 S 1300 E, STE 275, SANDY, UT 84094-4692
(801) 571-7061
(801) 571-9277
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 571-7061
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
3231151206
UT
363AS0400X
Surgical Physician Assistant
Primary
3231151206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107021850101
INTERMOUNTAIN HEALTH
UT
05
—
999000116008
—
UT
Enumeration date
04/05/2006
Last updated
04/22/2016
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