MEDICARE: ZACHARY PERRY PA-C, CAQ-PSYCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	11453778-1206	UT

General Provider Information

NPI Number	:	1265082242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY PERRY PA-C, CAQ-PSYCH

Provider Business Mailing Address
First Line	:	3080 S 2075 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2415
Country	:	US
Telephone Number	:	801-871-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 S HIGHLAND DR STE 250
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4200
Country	:	US
Telephone Number	:	801-871-5009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	06/15/2026

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