Provider Demographics
NPI:1407296809
Name:DILLE, BRETT RONALD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:RONALD
Last Name:DILLE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:#2400
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3271
Mailing Address - Country:US
Mailing Address - Phone:801-387-2750
Mailing Address - Fax:801-387-2755
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:#2400
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-2750
Practice Address - Fax:801-387-2755
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-07-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical