Healthcare Provider Details

I. General information

NPI: 1447363577
Provider Name (Legal Business Name): ERIC N. EITING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 GREEN ST
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5217 S STATE ST STE 200
MURRAY UT
84107-4812
US

V. Phone/Fax

Practice location:
  • Phone: 801-284-1755
  • Fax: 801-262-3897
Mailing address:
  • Phone: 801-284-1702
  • Fax: 801-262-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number122674-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number122674-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: