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General NPI Number Information
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NPI Number | 1265833834
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Entity Type | Individual
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Provider Name | TRENT R TIPTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 3420 S MERCY RD STE 107
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City | GILBERT
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State | AZ
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Zip | 85297-0420
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Country | US
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Telephone | 480-551-0300
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Fax | 480-649-3746
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Provider Business Mailing Address
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Address Line | PO BOX 2767
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City | SCOTTSDALE
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State | AZ
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Zip | 85252-2767
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Country | US
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Telephone | 480-551-0300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5829
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5829
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License Number State | AZ
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