Individual
KYLE RAYMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1281 N 600 E, LOGAN, UT 84341-6988
(435) 716-6400
(385) 297-2348
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13339650-1206
UT
363A00000X
Physician Assistant
MED-PAC-LIC-69721
MT
363AS0400X
Surgical Physician Assistant
MED-PAC-LIC-69721
MT
Other
Enumeration date
09/13/2018
Last updated
08/04/2023
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