Individual
ROBERT T LESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1055 N 500 W, SUITE 121, PROVO, UT 84604-3305
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
281253-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10703071610
IHC
UT
01
—
P00113519
PALMETTO
UT
Enumeration date
09/07/2006
Last updated
11/27/2023
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