Scott Lyles Provost, MD

NPI #1194843052 in Murray, Utah

Provider Information

NPI Number: 1194843052
Entity Type: Individual
Name: Scott Lyles Provost, MD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Anesthesiology
Credential: MD
Enumeration Date: Mar 27, 2007
Last Updated: Oct 16, 2012

Practice Location

Address: 5121 S COTTONWOOD STREET
Address 2: INTERMOUNTAIN MEDICAL CENTER
City: Murray
State: Utah
ZIP Code: 84157
Phone: (801) 507-5248

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Anesthesiology	207L00000X	Primary
Internal Medicine	207R00000X

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