Provider Demographics
NPI:1174270961
Name:MCDONALD, JEFFREY BRENT (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRENT
Last Name:MCDONALD
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 1:1878 E 5150 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6911
Mailing Address - Country:US
Mailing Address - Phone:801-633-2633
Mailing Address - Fax:
Practice Address - Street 1:3665 S 8400 W
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4907
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12607250-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant