Healthcare Provider Details

I. General information

NPI: 1689154148
Provider Name (Legal Business Name): CANYON VIEW MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 1000 E STE 100
PAYSON UT
84651-5592
US

IV. Provider business mailing address

15 S 1000 E STE 100
PAYSON UT
84651-5592
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-9802
  • Fax:
Mailing address:
  • Phone: 801-465-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON LOWE
Title or Position: ADMINSTRATOR
Credential:
Phone: 801-210-2651