Active NPI 1689069312 Individual Practitioner Male Practitioner

Bradley Evanson

Dermatology • St George, UT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Bradley Evanson is a certified Dermatology practicing in St George, UT. With approximately 11 years of clinical experience since graduating from Texas Tech University Health Science Center School Of Medicine in 2015, Bradley Evanson delivers high-quality medical care to the local community at 383 S 300 E.

Bradley Evanson is affiliated with Southwest Skin And Cancer Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

383 S 300 E

St George, UT 847703620

Telephone 4356282826

Associated Practice Facility / Clinic

🏢 Southwest Skin And Cancer Llc Facility NPI 1619929783

Medicare Profile & Education

Medical School

Texas Tech University Health Science Center School Of Medicine

Graduation Year

2015

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in St George, UT

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

11 Yrs -4.7 yrs vs City Avg

City Avg: 15.7 Yrs

State Avg: 19.7 Yrs

Regional Practice Density

12 Specialists

Practicing in St George, UT (184 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

39.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Evanson (11 Years) 11 Yrs

St George Specialty Average (15.7 Years) 15.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	5,357	821	$9.28	$6.28
99213 Established patient office or other outpatient visit, typically 15 minutes	1,889	1,335	$120.63	$86.87
17000 Destruction of skin growth	1,220	944	$93.06	$53.08
88305 Pathology examination of tissue using a microscope, intermediate complexity	785	511	$94.94	$68.03
11102 Tangential biopsy of single skin lesion	564	500	$135.58	$91.50
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	274	274	$148.28	$106.81
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	224	187	$898.78	$552.85
17004 Destruction of precancer skin growth, 15 or more growths	167	146	$219.83	$158.36
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	147	139	$172.20	$122.66
11103 Biopsy of related skin growth, each additional growth	134	105	$65.11	$47.62
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	122	104	$239.59	$157.65
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	115	84	$549.41	$392.26
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	112	40	$5.92	$0.98
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	91	75	$191.95	$121.03
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	90	88	$394.94	$282.04
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	88	85	$77.23	$53.88
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	80	72	$628.01	$229.16
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	58	51	$508.76	$389.29
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	43	39	$255.75	$167.94
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	37	36	$1012.35	$723.86
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	34	$225.39	$81.62
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	36	32	$239.02	$152.70
96573 Application of light by qualified health care professional to destroy precancer skin growth	34	34	$219.36	$180.71
88304 Pathology examination of tissue using a microscope, moderately low complexity	31	28	$56.63	$40.89
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	30	28	$371.37	$132.54
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	28	26	$568.22	$250.64
69100 Biopsy of ear	26	25	$131.26	$73.19
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	24	$326.51	$116.31
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	21	19	$278.77	$181.72
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	21	21	$224.18	$160.61
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	21	20	$183.56	$129.02
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	20	19	$221.90	$135.68
11104 Punch biopsy, first skin growth	20	20	$188.45	$116.72
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	18	16	$18.83	$13.39
99202 New patient office or other outpatient visit, typically 20 minutes	17	17	$97.46	$68.89
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	16	15	$675.44	$237.37
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	16	16	$397.01	$238.73
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	16	16	$261.32	$167.02
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	13	12	$853.86	$560.94
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	11	11	$433.99	$287.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,662	607	$10.15	$6.41
99213 Established patient office or other outpatient visit, typically 15 minutes	1,201	970	$112.85	$87.13
17000 Destruction of skin growth	824	711	$96.12	$56.05
88305 Pathology examination of tissue using a microscope, intermediate complexity	675	452	$93.21	$68.50
11102 Tangential biopsy of single skin lesion	368	357	$137.89	$95.12
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	306	306	$140.86	$108.30
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	197	180	$164.54	$122.59
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	177	155	$851.32	$582.46
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	158	48	$7.00	$1.07
17004 Destruction of precancer skin growth, 15 or more growths	148	133	$208.86	$162.23
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	94	72	$530.88	$396.43
11103 Biopsy of related skin growth, each additional growth	88	71	$58.73	$48.41
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	80	67	$186.05	$122.75
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	79	67	$226.27	$152.67
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	73	72	$76.75	$54.19
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	66	63	$360.36	$278.90
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	63	62	$608.48	$232.27
88304 Pathology examination of tissue using a microscope, moderately low complexity	45	42	$56.33	$40.41
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	45	45	$213.07	$162.53
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	32	29	$212.00	$83.04
99202 New patient office or other outpatient visit, typically 20 minutes	32	32	$99.06	$69.60
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	30	30	$544.40	$226.38
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	27	27	$356.00	$137.11
96573 Application of light by qualified health care professional to destroy precancer skin growth	26	26	$164.42	$159.62
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	22	18	$228.00	$139.54
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	20	20	$438.00	$384.50
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	20	20	$974.00	$739.71
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	19	15	$238.00	$152.28
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	18	18	$806.44	$578.78
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	15	15	$650.00	$242.60
11104 Punch biopsy, first skin growth	14	13	$207.36	$116.28
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	13	12	$401.15	$185.84
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	13	12	$490.69	$380.84
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	11	11	$244.00	$186.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	273	72	$13.00	$6.47
17003 Destruction of precancer skin growth, 2-14 growths	250	58	$20.00	$2.04
99213 Established patient office or other outpatient visit, typically 15 minutes	150	145	$110.20	$88.16
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	109	109	$140.00	$107.37
17000 Destruction of skin growth	109	107	$98.00	$58.40
99213 Established patient office or other outpatient visit, typically 15 minutes	102	100	$142.00	$64.91
88305 Pathology examination of tissue using a microscope, intermediate complexity	87	67	$125.00	$68.27
17000 Destruction of skin growth	73	72	$237.00	$47.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	57	55	$209.00	$94.97
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	55	46	$1896.00	$286.86
17110 Destruction of up to 14 skin growths	35	34	$324.00	$64.24
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	35	26	$1132.00	$181.80
11102 Tangential biopsy of single skin lesion	30	30	$160.00	$93.06
11102 Tangential biopsy of single skin lesion	24	24	$303.00	$26.49
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	23	$65.00	$54.95
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	22	21	$1000.00	$533.94
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	21	$127.62	$117.84
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	19	19	$275.00	$163.48
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$322.00	$130.89
99202 New patient office or other outpatient visit, typically 20 minutes	16	16	$110.00	$69.85
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	15	11	$600.00	$390.77
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	15	15	$210.00	$80.52
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	14	$225.00	$116.55
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	14	12	$858.00	$99.85
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	13	11	$250.00	$131.31

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	734	140	$20.00	$2.05
99213 Established patient office or other outpatient visit, typically 15 minutes	190	161	$142.00	$65.73
17000 Destruction of skin growth	190	167	$237.00	$47.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	182	152	$209.00	$96.08
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	140	97	$1896.00	$284.22
11102 Tangential biopsy of single skin lesion	98	91	$303.00	$26.83
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	94	57	$1132.00	$183.22
17110 Destruction of up to 14 skin growths	71	64	$324.00	$63.44
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	64	64	$210.00	$80.39
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	59	59	$322.00	$132.40
11103 Biopsy of related skin growth, each additional growth	56	33	$95.00	$21.41
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	39	37	$887.00	$126.39
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	35	33	$1389.00	$147.04
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	18	$724.00	$77.06
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	21	21	$858.00	$96.52
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	17	16	$2271.00	$569.98
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	17	17	$1247.00	$162.40
17004 Destruction of precancer skin growth, 15 or more growths	17	16	$495.00	$95.11
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	14	14	$1396.00	$163.20
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	14	13	$1729.00	$266.78
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	14	$823.00	$146.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	502	102	$20.00	$2.12
99213 Established patient office or other outpatient visit, typically 15 minutes	255	213	$142.00	$50.31
17000 Destruction of skin growth	148	131	$237.00	$48.86
99202 New patient office or other outpatient visit, typically 20 minutes	122	122	$145.00	$49.71
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	101	78	$1896.00	$296.79
11102 Tangential biopsy of single skin lesion	84	76	$303.00	$28.80
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	62	45	$1132.00	$192.32
17110 Destruction of up to 14 skin growths	54	50	$324.00	$64.45
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	52	49	$1389.00	$169.92
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	34	32	$1247.00	$205.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	20	18	$724.00	$77.04
11103 Biopsy of related skin growth, each additional growth	20	13	$95.00	$22.44
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	17	16	$209.00	$77.99
17004 Destruction of precancer skin growth, 15 or more growths	15	13	$495.00	$96.62
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	14	14	$887.00	$131.66
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	14	13	$2271.00	$607.89
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	12	11	$823.00	$103.37
11104 Punch biopsy, first skin growth	12	11	$303.00	$44.42
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	12	12	$1157.00	$203.42

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	172	39	$20.00	$2.34
99213 Established patient office or other outpatient visit, typically 15 minutes	101	97	$142.00	$49.70
99202 New patient office or other outpatient visit, typically 20 minutes	66	66	$145.00	$49.21
17000 Destruction of skin growth	51	49	$237.00	$44.73
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	43	39	$1896.00	$321.68
11102 Tangential biopsy of single skin lesion	37	35	$303.00	$31.05
17110 Destruction of up to 14 skin growths	31	31	$324.00	$65.25
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	24	24	$1389.00	$166.45
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	16	16	$1247.00	$195.72
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	14	12	$1132.00	$196.39

Medical Specialties & State Licenses

CMS Verified: 2022-09-27

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License UT 12603519-1205

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License TX S1396

Dermatology - MOHS-Micrographic Surgery

NUCC Taxonomy Code: 207ND0101X

State License UT 12603519-1205

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Hospital & Practice Group Affiliations

Southwest Skin And Cancer Llc

340 Falcon Ridge Pkwy, Mesquite, NV 890278851

Phone: 4356282846

Southwest Skin And Cancer Llc

383 S 300, St George, UT 847703620

Phone: 4356282826

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners

Dr. W Smith , MD

Dermatology

NPI 1164499836

Doctor of Medicine (M.D.)

Tim Nowatzke , PA-C

Physician Assistant

NPI 1215989645

Physician Assistant (Certified)

Kyle Eardley , PA-C

Physician Assistant

NPI 1376369231

Physician Assistant (Certified)

Dr. Wallace Smith , MD

Dermatology

NPI 1376800532

Doctor of Medicine (M.D.)

Dr. Dean Duke , MD

Dermatology

NPI 1508832726

Doctor of Medicine (M.D.)

Jordan Christensen , FNP-C

Nurse Practitioner - Family

NPI 1689016875

Family Nurse Practitioner (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events

📍

Updated Practice Location September 27, 2022

Registered at 383 S 300 E, ST GEORGE, UT 847703620 (Tel: 4356282826)

📍

Updated Business Mailing Address September 27, 2022

Registered at 383 S 300 E, ST GEORGE, UT 847703620 (Tel: 3546282826)

📍

Updated Business Mailing Address June 27, 2019

Registered at PO BOX 844658, DALLAS, TX 752844658 (Tel: 2547248800)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 27, 2019

Dermatology (License #S1396 in TX)

📍

Updated Practice Location April 08, 2019

Registered at 2401 S 31ST ST BLDG 27, TEMPLE, TX 765081261 (Tel: 2547246477)

📍

Updated Business Mailing Address April 08, 2019

Registered at 2401 S 31ST ST BLDG 27, TEMPLE, TX 765081261 (Tel: 2547246477)

✅

NPI Profile Active March 31, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location March 31, 2015

Registered at 1633 N CAPITOL AVE, STE 640, INDIANAPOLIS, IN 462021261 (Tel: 3179628881)

📍

Updated Business Mailing Address March 31, 2015

Registered at 1633 N CAPITOL AVE, STE 640, INDIANAPOLIS, IN 462021261 (Tel: 3179628881)

👤

Provider Name / Credentials Updated March 31, 2015

Recorded as BRADLEY EVANSON

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 31, 2015

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration March 31, 2015

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1689069312

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: March 31, 2015

Last Update: September 27, 2022

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

383 S 300 E

St George, UT 847703620

Phone: 3546282826

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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