Healthcare Provider Details

I. General information

NPI: 1699238436
Provider Name (Legal Business Name): VERNON MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 118
LOGAN UT
84341-2691
US

IV. Provider business mailing address

630 E 1400 N STE 118
LOGAN UT
84341-2691
US

V. Phone/Fax

Practice location:
  • Phone: 435-799-7953
  • Fax: 435-514-7977
Mailing address:
  • Phone: 435-799-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN A VERNON
Title or Position: OWNER
Credential: MD
Phone: 435-799-7953