Individual
DALE JERRY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
85 N MEDICAL DR, SALT LAKE CITY, UT 84132-1428
(801) 213-8584
Mailing address
85 N MEDICAL DR, SALT LAKE CITY, UT 84112-1100
(801) 213-8584
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11918961-1206
UT
Other
Enumeration date
07/16/2019
Last updated
10/24/2022
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