Provider Demographics
NPI:1922275999
Name:LANCE R BRYCE
Entity Type:Organization
Organization Name:LANCE R BRYCE
Other - Org Name:CANYON SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-951-2349
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:SUITE
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0268
Mailing Address - Country:US
Mailing Address - Phone:801-951-2349
Mailing Address - Fax:801-951-2389
Practice Address - Street 1:984 S 500 W
Practice Address - Street 2:STE 2
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3604
Practice Address - Country:US
Practice Address - Phone:801-951-2349
Practice Address - Fax:801-951-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81409208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty