Healthcare Provider Details

I. General information

NPI: 1235173543
Provider Name (Legal Business Name): BRIAN T NORMAN PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12523 S CREEK MEADOW RD STE 109
RIVERTON UT
84065-7299
US

IV. Provider business mailing address

1015 E 32ND ST SUITE 200
AUSTIN TX
78705-2707
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-0735
  • Fax: 512-583-1099
Mailing address:
  • Phone: 512-476-2830
  • Fax: 512-583-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9557601-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9557601-1206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: