Individual
BRYAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
680 E MAIN ST STE 201, LEHI, UT 84043-2251
(801) 768-8800
Mailing address
13658 S FORT ST, DRAPER, UT 84020-9278
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12537569-1206
UT
Other
Enumeration date
11/01/2021
Last updated
02/10/2023
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