Healthcare Provider Details

I. General information

NPI: 1770558090
Provider Name (Legal Business Name): BRYAN C HOELZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N, STE. 110
VINEYARD UT
84058
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-0246
  • Fax: 385-203-0245
Mailing address:
  • Phone: 435-215-0230
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number10170105-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number10170105-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: