Graduated: 2003
NPI: 1407956121
Practice Locations (2)
IMPACT PHYSICIAN GROUP LLC
306 W RIVER BEND LN
PROVO, UT 846045625
8012268880
IMPACT PHYSICIAN GROUP LLC
5825 HARRISON BLVD
SOUTH OGDEN, UT 844034316
8014755254
Source: CMS National Downloadable File, September 2026.