Healthcare Provider Details

I. General information

NPI: 1982869210
Provider Name (Legal Business Name): SCOTT D TAYLOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 WOODROW ST STE 102
MURRAY UT
84107-5853
US

IV. Provider business mailing address

5444 GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPENDING
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: