Individual
JORDAN ANTHONY LYTHGOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1055 N 300 W STE 205, PROVO, UT 84604-5044
(801) 374-9100
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10520107-1206
UT
Other
Enumeration date
03/31/2017
Last updated
10/03/2017
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