Provider Demographics
NPI:1366803736
Name:BRYCE DEE ALLRED MD A PC
Entity type:Organization
Organization Name:BRYCE DEE ALLRED MD A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-569-2456
Mailing Address - Street 1:3584 W 9000 S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5710
Mailing Address - Country:US
Mailing Address - Phone:801-569-2456
Mailing Address - Fax:801-569-2080
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5710
Practice Address - Country:US
Practice Address - Phone:801-569-2456
Practice Address - Fax:801-569-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5295820700000Medicaid
UTD07525Medicare UPIN