Individual
MR. JOHN WALKER LELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
(801) 507-4017
(801) 507-4809
Mailing address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
(801) 507-4000
(801) 507-4809
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8516577-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275812208
—
UT
Enumeration date
08/09/2011
Last updated
04/16/2021
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