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Individual

WAYNE GRANT CRAWFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
7302 S BINGHAM JUNCTION BLVD, MIDVALE, UT 84047-4804
(801) 442-2611
Mailing address
PO BOX 2712, SALT LAKE CITY, UT 84110-2712
(801) 442-5502

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
105738-1206
UT
363AM0700X
Medical Physician Assistant
2209
AK
363AM0700X
Medical Physician Assistant
T12/22/2013
TX

Other

Enumeration date
04/03/2006
Last updated
01/26/2017
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