Individual
TRACY R SYDDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1525 W 2100 S, SALT LAKE CITY, UT 84119-1401
(801) 213-9700
Mailing address
10479 S SAGE VISTA WAY, SOUTH JORDAN, UT 84095-3955
(801) 243-6178
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7270173-1206
UT
Other
Enumeration date
04/24/2009
Last updated
12/13/2021
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