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General NPI Number Information
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NPI Number | 1568789295
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Entity Type | Individual
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Provider Name | BRYANT OLIVERSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 3485 W 5200 S STE 209
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City | ROY
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State | UT
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Zip | 84067-9438
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Country | US
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Telephone | 801-475-3900
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Fax | 801-475-3901
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Provider Business Mailing Address
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Address Line | PO BOX 5546
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City | DENVER
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State | CO
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Zip | 80217-5546
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Country | US
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Telephone | 801-475-3500
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Fax | 801-475-3414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 9690207-1205
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License Number State | UT
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