Individual
MR. BRADLEY B ANDREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
52 N 1100 E, AMERICAN FORK, UT 84003-2952
(801) 769-0901
(801) 769-0903
Mailing address
52 N 1100 E, AMERICAN FORK, UT 84003-2952
(801) 769-0901
(801) 769-0903
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6546889-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6546889-1206
STATE LICENSE
UT
Enumeration date
04/19/2007
Last updated
07/08/2007
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