Healthcare Provider Details

I. General information

NPI: 1609253962
Provider Name (Legal Business Name): SCOTT S BOWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11444 S REDWOOD RD
SOUTH JORDAN UT
84095-7803
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-5900
  • Fax: 385-297-2771
Mailing address:
  • Phone: 801-253-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9317717-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9317717-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: