Provider Demographics
NPI:1548540271
Name:HESS, BRIAN D (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:HESS
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 1:1030 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3050
Mailing Address - Country:US
Mailing Address - Phone:435-723-9700
Mailing Address - Fax:435-723-9710
Practice Address - Street 1:1030 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3050
Practice Address - Country:US
Practice Address - Phone:435-723-9700
Practice Address - Fax:435-723-9710
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8446648-1206363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical