Healthcare Provider Details

I. General information

NPI: 1104844224
Provider Name (Legal Business Name): DAVID LAWRENCE DEATON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MEDICAL DR
MT PLEASANT UT
84647-2222
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-3471
  • Fax:
Mailing address:
  • Phone: 435-462-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA654
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8469216-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: