MR. Ty Dallas Mangum, PA

NPI #1194340158 in St George, Utah

Provider Information

NPI Number: 1194340158
Entity Type: Individual
Name: MR. Ty Dallas Mangum, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Jun 15, 2020
Last Updated: Jan 4, 2022

Practice Location

Address: 595 W 600 N
City: St George
State: Utah
ZIP Code: 84770-2609
Phone: (435) 680-2309

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Physician Assistant	363A00000X	Primary

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