Healthcare Provider Details

I. General information

NPI: 1528275898
Provider Name (Legal Business Name): RYAN C. OLLERTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 1220 E SUITE # 7
AMERICAN FORK UT
84003-2089
US

IV. Provider business mailing address

120 N 1220 E SUITE # 7
AMERICAN FORK UT
84003-2089
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9635
  • Fax:
Mailing address:
  • Phone: 801-756-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6564844-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: