Individual
BRIAN T BODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1975 N STATE ST, OREM, UT 84057-2028
(801) 714-5000
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 714-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7060654-1206
UT
363AM0700X
Medical Physician Assistant
1391
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052790A
—
OK
Enumeration date
11/04/2005
Last updated
07/25/2011
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