Elise Brinson Fazio, DO
Family Medicine in Ogden, UT. Individual provider (NPI-1).
NPI number1710366299
StatusActive
Last updated in NPPESNov 14, 2019
Details
- NPI
- 1710366299
- Entity type
- Individual (NPI-1)
- Name
- Elise Brinson Fazio
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 29, 2015
- Last updated
- Nov 14, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 11176326-1204 | UT | Yes |
Practice location
4403 Harrison Blvd Ste 3630Ogden, UT 84403-3287
Phone 801-387-7900
Mailing address
Po Box 27128Salt Lake City, UT 84127-0128
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