Healthcare Provider Details

I. General information

NPI: 1396662847
Provider Name (Legal Business Name): BRAD M ASH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

1720 S PERRY HOLLOW DR
MAPLETON UT
84664-5597
US

V. Phone/Fax

Practice location:
  • Phone: 891-357-7272
  • Fax: 891-357-7037
Mailing address:
  • Phone: 801-357-7272
  • Fax: 801-357-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number113240
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: