MEDICARE: MR. JONATHAN THOMAS BAIRD PA-C, ATC

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	6309270-1206	UT

General Provider Information

NPI Number	:	1578525200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN THOMAS BAIRD PA-C, ATC

Provider Business Mailing Address
First Line	:	10433 S REDWOOD RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:	801-260-1919
Fax Number	:	801-260-1441

Provider Business Practice Location Address
First Line	:	10433 S REDWOOD RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:	801-260-1919
Fax Number	:	801-260-1441

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/30/2016

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