Healthcare Provider Details

I. General information

NPI: 1649544198
Provider Name (Legal Business Name): G BRYANT SALMON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N 1700 W
LAYTON UT
84041
US

IV. Provider business mailing address

2883 CHIPPEWA WAY
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax:
Mailing address:
  • Phone: 801-615-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8227253-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: