Provider Demographics
NPI:1316599673
Name:CRANE, BROGAN K (PA-S)
Entity Type:Individual
Prefix:
First Name:BROGAN
Middle Name:K
Last Name:CRANE
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 GUNLOCK CT
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6705
Mailing Address - Country:US
Mailing Address - Phone:801-915-2653
Mailing Address - Fax:
Practice Address - Street 1:1898 GUNLOCK CT
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6705
Practice Address - Country:US
Practice Address - Phone:801-915-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119216021206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant