Clark, Bryan A

Clark, Bryan A is an individual health care provider with primary practice located at 9844 S 1300 E Ste 275, Sandy UT 84094-4692. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Clark, Bryan A can be contacted via phone (801) 571-7061.

Contact Information

Primary practice address
9844 S 1300 E Ste 275 Sandy UT 84094-4692
Phone: (801) 571-7061
Fax: (801) 571-9277
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 3231151206 Utah
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 3231151206 Utah

Profile Details

NPI number 1093777047
LBN Legal business name Clark, Bryan A
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2006
Last updated Apr 22nd, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093777047 NPPES
Utah Other 107021850101 INTERMOUNTAIN HEALTH
Utah MEDICAID 999000116008 INTERMOUNTAIN HEALTH

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