Individual
MR. TY DALLAS MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
595 W 600 N, ST GEORGE, UT 84770-2609
(435) 680-2309
Mailing address
595 W 600 N, ST GEORGE, UT 84770-2609
(435) 680-2309
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008692
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2020
Last updated
01/04/2022
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