MEDICARE: MR. CORY LANNING BRITTON III P.A.

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	100638-1206	UT

General Provider Information

NPI Number	:	1598999336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORY LANNING BRITTON III P.A.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	801-294-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	1950 E 7000 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6894
Country	:	US
Telephone Number	:	801-943-3300
Fax Number	:	801-943-3461

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	01/28/2010

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