Provider Demographics
NPI:1487999488
Name:HAINSWORTH, BRYAN (PA-C)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HAINSWORTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 N 2000 W # 203
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9219
Mailing Address - Country:US
Mailing Address - Phone:801-689-3389
Mailing Address - Fax:801-689-2320
Practice Address - Street 1:2850 N 2000 W # 203
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9219
Practice Address - Country:US
Practice Address - Phone:801-689-3389
Practice Address - Fax:801-689-2320
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6801881-1206363AM0700X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical