LUCIUS NMN GORDON

ROY, UT
NPI1396814778
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: UT  10495233-1206)
Additional Taxonomies363A00000X Physician Assistant
Enumeration Date2006-11-07
Last Update Date2018-03-17
Business Address
Mr. LUCIUS NMN GORDON PA-C
5640 S 3500 W
ROY, UT 84067-9158
Phone number: 801-773-2838
Mailing Address
Mr. LUCIUS NMN GORDON PA-C
1055 N 500 W ATTN: CREDENTIALING
PROVO, UT 84604-3305
Phone number: 801-354-8225