Healthcare Provider Details

I. General information

NPI: 1598910101
Provider Name (Legal Business Name): MATT SCOTT FRANCOM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2973 W 125 S
WEST POINT UT
85015
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3960
  • Fax: 801-475-3961
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2945431206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: