Healthcare Provider Details

I. General information

NPI: 1851916993
Provider Name (Legal Business Name): ROBERT DUNCAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 W PACIFIC AVE
SALT LAKE CITY UT
84104-2372
US

IV. Provider business mailing address

1143 W PACIFIC AVE
SALT LAKE CITY UT
84104-2372
US

V. Phone/Fax

Practice location:
  • Phone: 801-703-6133
  • Fax:
Mailing address:
  • Phone: 801-703-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: