MEDICARE: MR. ROBERT ANDREW SERPICO PA-C, MSPAC

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	363AM0700X	Medical Physician Assistant	7472700-1206	UT

General Provider Information

NPI Number	:	1851628218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ANDREW SERPICO PA-C, MSPAC

Provider Business Mailing Address
First Line	:	924 LORRAINE AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2045
Country	:	US
Telephone Number	:	801-891-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 N UNIVERSITY AVE
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-2658
Country	:	US
Telephone Number	:	801-377-4745
Fax Number	:	801-373-5762

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

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/18/2021

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Directions to “ MR. ROBERT ANDREW SERPICO PA-C, MSPAC” Practice Location

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