MEDICARE: TIMOTHY A DENNIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	104445-1206	UT

General Provider Information

NPI Number	:	1376541102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY A DENNIS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1096
Second Line	:
City	:	PANGUITCH
State	:	UT
Zip	:	84759
Country	:	US
Telephone Number	:	435-676-8758
Fax Number	:	435-676-2679

Provider Business Practice Location Address
First Line	:	224 N. 400 EAST
Second Line	:
City	:	PANGUITCH
State	:	UT
Zip	:	84759
Country	:	US
Telephone Number	:	435-676-8842
Fax Number	:	435-676-2679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2007

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Directions to “ TIMOTHY A DENNIS PA-C” Practice Location

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