Provider Demographics
NPI:1386042760
Name:MCVEY, JOHN RICHARD (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:MCVEY
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 1:550 E 1400 N
Mailing Address - Street 2:STE J
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2450
Mailing Address - Country:US
Mailing Address - Phone:435-753-1171
Mailing Address - Fax:435-792-4464
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-531-9453
Practice Address - Fax:801-531-9467
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9235918-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant