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Individual

LISA BYRD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C.

Contact information

Practice address
5896 S RIDGELINE DR, SUITE B, OGDEN, UT 84405-6779
(801) 866-0170
(801) 866-0169
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7973035-1206
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
031828
MEDICARE
AZ
01
61788
MEDICARE
AZ
Enumeration date
05/27/2005
Last updated
11/27/2023
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