Healthcare Provider Details

I. General information

NPI: 1750471389
Provider Name (Legal Business Name): JASON SIDNEY BIGGS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

14201 S CROWN ROSE DR
HERRIMAN UT
84096-6548
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3500
  • Fax:
Mailing address:
  • Phone: 801-580-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number340538-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: