Individual
MR. BRUCE MCCLANAHAN BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3152 NORTH UNIVERSITY AVE, SUITE 120, PROVO, UT 84604
(801) 375-2177
Mailing address
11119 S PRESCOTT PARK CIR, SANDY, UT 84092-5098
(801) 562-0058
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1033258906
UT
Other
Enumeration date
05/08/2007
Last updated
12/27/2013
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