Healthcare Provider Details

I. General information

NPI: 1477072015
Provider Name (Legal Business Name): BRIAN GRIER MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 E 80 N
AMERICAN FORK UT
84003-2906
US

IV. Provider business mailing address

PO BOX 30079
SALT LAKE CITY UT
84130-0079
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-3885
  • Fax: 801-763-3887
Mailing address:
  • Phone: 801-375-8858
  • Fax: 801-429-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10516534-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: