Individual
DR. LANCE DUSTIN EDMONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N 500 W STE 112, PROVO, UT 84604-3305
(801) 812-4624
(801) 812-4699
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
380515-1205
UT
2085R0202X
Diagnostic Radiology Physician
A108694
CA
Other
Enumeration date
09/21/2007
Last updated
03/20/2025
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