MEDICARE: ISAIAH GARRETT PARRY

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
1	363A00000X	Physician Assistant	14247850-1206	UT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578311072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAIAH GARRETT PARRY

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:	ATTN CREDENTIALING
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	1055 N 500 W
Second Line	:	STE 212 BLDG C
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-373-4366
Fax Number	:	801-429-8191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	12/08/2025

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