MEDICARE: DARRIN JON COTTLE 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	7428364-1206	UT
2	363AM0700X	Medical Physician Assistant	7428364-8906	UT
3	133V00000X	Registered Dietitian	7428364-4901	UT

General Provider Information

NPI Number	:	1720413974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRIN JON COTTLE PA-C

Provider Business Mailing Address
First Line	:	565 S KOMAS DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1208
Country	:	US
Telephone Number	:	801-584-5144
Fax Number	:	801-584-5206

Provider Business Practice Location Address
First Line	:	565 S KOMAS DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1208
Country	:	US
Telephone Number	:	801-584-5144
Fax Number	:	801-584-5206

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	04/23/2026

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