Individual
BRENTON WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
565 KOMAS DRIVE, SALT LAKE CITY, UT 84108
(801) 584-5144
(801) 584-5206
Mailing address
565 KOMAS DRIVE, SALT LAKE CITY, UT 84108
(801) 584-5144
(801) 584-5206
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
UT
Other
Enumeration date
04/26/2017
Last updated
02/14/2019
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