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NPI Code Detail

MEDICARE: RYAN L THUESON PA-C

MEDICARE: RYAN L THUESON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant8528275-1206UT
2363A00000XPhysician Assistant5369AZ

General Provider Information

NPI Number : 1023359080
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN L THUESON PA-C
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5171 S COTTONWOOD ST STE 210
Second Line :
City : MURRAY
State : UT
Zip : 84107-5718
Country : US
Telephone Number : 801-507-3380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2013
Last Update Date : 04/08/2026

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Directions to “ RYAN L THUESON PA-C” Practice Location

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