Healthcare Provider Details

I. General information

NPI: 1720413974
Provider Name (Legal Business Name): DARRIN JON COTTLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 S KOMAS DR
SALT LAKE CITY UT
84108-1208
US

IV. Provider business mailing address

565 S KOMAS DR
SALT LAKE CITY UT
84108-1208
US

V. Phone/Fax

Practice location:
  • Phone: 801-584-5144
  • Fax: 801-584-5206
Mailing address:
  • Phone: 801-584-5144
  • Fax: 801-584-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7428364-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7428364-8906
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7428364-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: