Provider Demographics
NPI:1053838532
Name:THOMAS, JOHN EVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EVAN
Last Name:THOMAS
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 1:848 E 750 N
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2853
Mailing Address - Country:US
Mailing Address - Phone:801-821-3649
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E RM 3B420
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-213-2700
Practice Address - Fax:801-585-2891
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10403324-8906208800000X
UT10403324-1206363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208800000XAllopathic & Osteopathic PhysiciansUrology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant