Provider Demographics
NPI:1033671193
Name:BUCK, SKYLER VANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:VANCE
Last Name:BUCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 W MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2177
Mailing Address - Country:US
Mailing Address - Phone:435-233-0248
Mailing Address - Fax:
Practice Address - Street 1:1380 E MEDICAL CENTER DR STE 1500
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2128
Practice Address - Country:US
Practice Address - Phone:435-251-2500
Practice Address - Fax:435-251-2525
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11534759-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant