Individual
BLAKE LYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1160 E 3900 S STE 5000, SALT LAKE CITY, UT 84124-1275
(801) 261-7479
(801) 261-7429
Mailing address
PO BOX 100253, ATLANTA, GA 30384-0253
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9705935-1206
UT
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/04/2013
Last updated
11/13/2023
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