Healthcare Provider Details

I. General information

NPI: 1952436826
Provider Name (Legal Business Name): UROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 E 500 S
ST GEORGE UT
84770-3667
US

IV. Provider business mailing address

391 E 500 S
ST GEORGE UT
84770-3667
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-3606
  • Fax: 435-628-8404
Mailing address:
  • Phone: 435-628-3606
  • Fax: 435-628-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateUT

VIII. Authorized Official

Name: DR. BRYAN ELLSWORTH
Title or Position: PHYSICIAN
Credential: MD
Phone: 435-628-3606