Individual
LUCAS WADDOUPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4381 S 900 E, SOUTH OGDEN, UT 84403-2911
(801) 837-7274
Mailing address
4381 S 900 E, SOUTH OGDEN, UT 84403-2911
(801) 837-7274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11950477-1206
UT
Other
Enumeration date
07/24/2019
Last updated
12/16/2021
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