Provider Demographics
NPI:1225047996
Name:O'VERY, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:O'VERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:A
Other - Last Name:O VERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1325 N 600 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6743
Mailing Address - Country:US
Mailing Address - Phone:435-213-3970
Mailing Address - Fax:435-355-3746
Practice Address - Street 1:1325 N 600 E
Practice Address - Street 2:STE 101
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-750-5599
Practice Address - Fax:435-750-0861
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372602-1205207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005750701Medicare ID - Type Unspecified
G41237Medicare UPIN