Healthcare Provider Details

I. General information

NPI: 1710814165
Provider Name (Legal Business Name): CAMDEN BRYAN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 N 1900 E
SALT LAKE CITY UT
84132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax: 801-581-4367
Mailing address:
  • Phone: 801-581-6393
  • Fax: 801-581-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: