Healthcare Provider Details

I. General information

NPI: 1114453826
Provider Name (Legal Business Name): BRYCE KAY WARR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 100 N
PRICE UT
84501-2504
US

IV. Provider business mailing address

317 E 100 N
PRICE UT
84501-2504
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-3584
  • Fax: 435-637-3587
Mailing address:
  • Phone: 435-637-3584
  • Fax: 435-637-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7355749-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: