Individual
MR. TANNER LEE FREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 358-1076
Mailing address
245 W 500 N, LINDON, UT 84042-1302
(801) 358-1076
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
1153249
UT
363A00000X
Physician Assistant
Primary
10931513-1206
UT
Other
Enumeration date
07/19/2018
Last updated
07/13/2019
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