Healthcare Provider Details

I. General information

NPI: 1154574390
Provider Name (Legal Business Name): BRICE JASON WILLIAMS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD. SUITE 3600
OGDEN UT
84403-3285
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 3600
OGDEN UT
84403-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3550
  • Fax: 801-387-3555
Mailing address:
  • Phone: 801-387-3550
  • Fax: 801-387-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7471494-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: