Provider Demographics
NPI:1487963112
Name:NORTH CANYON FAMILY MEDICINE AND AESTHETICS LLC
Entity type:Organization
Organization Name:NORTH CANYON FAMILY MEDICINE AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:F
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-505-0820
Mailing Address - Street 1:307 WEST 200 SOUTH
Mailing Address - Street 2:SUITE 3006
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1259
Mailing Address - Country:US
Mailing Address - Phone:801-451-6060
Mailing Address - Fax:801-363-2533
Practice Address - Street 1:3263 S HIGHWAY 89
Practice Address - Street 2:SUITE 300
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8555
Practice Address - Country:US
Practice Address - Phone:801-296-0600
Practice Address - Fax:801-298-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty