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General NPI Number Information
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NPI Number | 1720482086
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Entity Type | Individual
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Provider Name | SCOTT MACDONALD PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1760 N 200 E STE 101
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City | NORTH LOGAN
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State | UT
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Zip | 84341
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Country | US
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Telephone | 435-787-0560
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Fax | 435-752-4673
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Provider Business Mailing Address
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Address Line | 1760 N 200 E STE 101
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1202
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Country | US
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Telephone | 435-787-0560
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Fax | 435-752-4673
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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 | 9174289-1206
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License Number State | UT
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