Individual
JAMES RIELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
395 W COUGAR BLVD STE 503, PROVO, UT 84604-3323
(801) 374-9100
(801) 374-9117
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
249582
NY
2086S0129X
Vascular Surgery Physician
Primary
11889299-1205
UT
2086S0129X
Vascular Surgery Physician
83219
SC
2086S0129X
Vascular Surgery Physician
MD469103
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
832193
—
SC
Enumeration date
09/08/2005
Last updated
03/14/2024
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