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1588635627
RANDAL N ELLSWORTH
PROVO, UT
NPI
1588635627
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
174400000X Specialist
(Licence: UT 942742051205)
Enumeration Date
2006-01-27
Last Update Date
2007-07-08
Business Address
Dr. RANDAL N ELLSWORTH MD
1735 N STATE ST
PROVO, UT 84604-1010
Phone number: 801-374-1818
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Mailing Address
Dr. RANDAL N ELLSWORTH MD
510 W 650 S
OREM, UT 84058-6136
Phone number: 801-225-1717
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