Healthcare Provider Details

I. General information

NPI: 1295567345
Provider Name (Legal Business Name): EMILY BAHR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 S COMMERCE DR STE 550
SALT LAKE CITY UT
84107-4736
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-4110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14270960-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: