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Individual

MR. GARY E NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
150 E CENTER ST, SUITE 1100, PROVO, UT 84606-3106
(801) 374-7011
(801) 374-7009
Mailing address
150 E CENTER ST, SUITE 1100, PROVO, UT 84606-3106
(801) 374-7011
(801) 374-7009

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
105991-1206
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05664
UT
Enumeration date
05/01/2006
Last updated
01/02/2013
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