Brigham Young University

NPI #1790175628 in Provo, Utah

Provider Information

NPI Number: 1790175628
Entity Type: Organization
Organization Name: Brigham Young University
Primary Specialty: Family Medicine
Enumeration Date: Jan 30, 2015
Last Updated: May 11, 2017

Practice Location

Address: 173 RICHARDS BUILDING
Address 2: DANCE DEPARTMENT
City: Provo
State: Utah
ZIP Code: 84602-2000
Phone: (972) 367-4845

Authorized Official

Name: MOUZON BASS III
Title: AGENT
Phone: (972) 367-4845

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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