Provider Demographics
NPI:1427037738
Name:SEARLE, BRYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SEARLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-710-2763
Mailing Address - Fax:
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:801-927-1591
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5131569-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT06-1506129OtherTIN