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General NPI Number Information
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NPI Number | 1710402540
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Entity Type | Individual
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Provider Name | SETH M GRISHAM PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 555 W STATE ROAD 164
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City | SALEM
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State | UT
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Zip | 84653-5732
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Country | US
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Telephone | 801-465-4896
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 N 500 W ATTN CREDENTIALING
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City | PROVO
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State | UT
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Zip | 84604-3305
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Country | US
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Telephone | 801-354-8225
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Fax |
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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 |
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License Number State |
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