Individual
DR. RANDAL N ELLSWORTH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 374-1818
(801) 379-2959
Mailing address
510 W 650 S, OREM, UT 84058-6136
(801) 225-1717
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
942742051205
UT
Other
Enumeration date
01/27/2006
Last updated
07/08/2007
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