NPI Code Detail JSON Logo

1336881408 NPI number — PHILLIP JAMES GOETZ PA-S

NPI Number: 1336881408
Health Care Provider/Practitioner: PHILLIP JAMES GOETZ PA-S

Information about “1336881408” NPI (PHILLIP JAMES GOETZ PA-S) exists in 1336881408 in HTML format HTML  |  1336881408 in plain Text format TXT  |  1336881408 in PDF (Portable Document Format) PDF  |  1336881408 in an XML format XML  formats.

NPI Number : 1336881408 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336881408",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOETZ",
    "FirstName": "PHILLIP",
    "MiddleName": "JAMES",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PA-S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GOETZ",
    "OtherFirstName": "PHILLIP",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PJ GOETZ",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "13142 S EAGLE PEAK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERRIMAN",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84096-6969",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-636-9608",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13142 S EAGLE PEAK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HERRIMAN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84096-6969",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-636-9608",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/10/2022",
    "LastUpdateDate": "10/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "142376661206",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.