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Individual

BRYAN WILLIAM LUNDBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4071 S 4000 W, WEST VALLEY CITY, UT 84120-4143
(801) 265-0103
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 954-7672
(801) 492-2235

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8905020-1206
UT
363A00000X
Physician Assistant

Other

Enumeration date
01/02/2014
Last updated
06/07/2024
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