Doctor Name: | BRYAN HAINSWORTH |
NPI Number: | 1487999488 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 6801881-1206 |
Business Practice Address: | 2850 N 2000 W # 203 Farr West, UT - 844049219 |
Business Phone Number: | 8016893389 |
Business Fax Number: | 8016892320 |
Mailing Address: | 2850 N 2000 W # 203, FARR WEST |
State: | UT |
Postal Code: | 844049219 |
Phone Number: | 8016893389 |
Fax Number: | 8016892320 |
NPI Enumeration Date: | 12/01/2012 |
NPI Last Update Date: | 09/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 6801881-1206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |