Healthcare Provider Details

I. General information

NPI: 1881881183
Provider Name (Legal Business Name): PHILLIP DARRELL BECK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 S JORDAN LANDING BLVD SUITE 200
WEST JORDAN UT
84084-5610
US

IV. Provider business mailing address

7611 S JORDAN LANDING BLVD SUITE 200
WEST JORDAN UT
84084-5610
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax:
Mailing address:
  • Phone: 801-260-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number295966-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: