Individual
BRIAN TODD SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-8586
(801) 357-7786
Mailing address
6325 W 10150 N, HIGHLAND, UT 84003-3453
(801) 850-2071
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9155350-1206
UT
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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