Provider Demographics
NPI:1699238436
Name:VERNON MEDICAL PLLC
Entity type:Organization
Organization Name:VERNON MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-799-7953
Mailing Address - Street 1:630 E 1400 N STE 118
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2691
Mailing Address - Country:US
Mailing Address - Phone:435-799-7953
Mailing Address - Fax:
Practice Address - Street 1:630 E 1400 N STE 118
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2691
Practice Address - Country:US
Practice Address - Phone:435-799-7953
Practice Address - Fax:435-514-7977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERNON MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty