Individual
MR. BRADY JOHN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2121 N 1700 W, LAYTON, UT 84041-8803
(801) 773-4840
(801) 525-8151
Mailing address
PO BOX 337, LAYTON, UT 84041-0337
(801) 773-4840
(801) 525-8151
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
8612587-1206
UT
363A00000X
Physician Assistant
Primary
8612587-1206
UT
363A00000X
Physician Assistant
PA-981
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-981
STATE LICENSE
ID
Enumeration date
06/05/2012
Last updated
02/13/2020
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