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General NPI Number Information
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NPI Number | 1578711057
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Entity Type | Individual
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Provider Name | BREONY STODDARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 74 E KIMBALLS LN STE 260
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City | DRAPER
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State | UT
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Zip | 84020-5009
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Country | US
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Telephone | 801-895-3146
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Fax | 801-850-6611
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Provider Business Mailing Address
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Address Line | 520 MEDICAL DR STE 300
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8925
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Country | US
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Telephone | 801-292-1422
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Fax | 801-296-0436
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 70914401206
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License Number State | UT
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