Individual
G RICHARD ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
520 MEDICAL DR, SUITE #310, BOUNTIFUL, UT 84010-4968
(801) 397-3000
(801) 397-0455
Mailing address
520 MEDICAL DR, SUITE #310, BOUNTIFUL, UT 84010-4968
(801) 397-3000
(801) 397-0455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
265444-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477643179
GROUP NPI
UT
Enumeration date
04/17/2007
Last updated
04/04/2016
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