Individual
REAGAN FAILS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1059 N 100 W, BEAVER, UT 84713-1690
(435) 438-7280
(435) 438-7210
Mailing address
PO BOX 1690, BEAVER, UT 84713-1690
(435) 438-7280
(435) 438-7210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9140864-1206
UT
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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