MEDICARE: CLAYTON GROVER PA-C

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	13099402-1206	UT
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1659088847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON GROVER PA-C

Provider Business Mailing Address
First Line	:	3624 S 3050 W
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6831
Country	:	US
Telephone Number	:	801-564-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 410
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1364
Country	:	US
Telephone Number	:	801-281-5996
Fax Number	:

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

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	05/02/2023

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Directions to “ CLAYTON GROVER PA-C” Practice Location

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