Individual
JUSTIN D. PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N 1900 E RM 1C301, SALT LAKE CITY, UT 84132-0002
(801) 585-2589
Mailing address
30 N 1900 E RM 1C301, SALT LAKE CITY, UT 84132-0002
(801) 585-2589
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
12017642-1205
UT
Other
Enumeration date
03/25/2019
Last updated
11/05/2020
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