Individual
MR. CHASE BRANDON FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10438332-1206
UT
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/17/2012
Last updated
01/22/2026
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