Healthcare Provider Details

I. General information

NPI: 1851587133
Provider Name (Legal Business Name): TRAVIS MARK REMINGTON MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 COTTONWOOD ST SUITE# 410
MURRAY UT
84107-6767
US

IV. Provider business mailing address

5169 COTTONWOOD ST SUITE# 410
MURRAY UT
84107-6767
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1650
  • Fax: 801-507-1625
Mailing address:
  • Phone: 801-507-1650
  • Fax: 801-507-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4859842-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4859842-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: