Provider Demographics
NPI:1467440701
Name:ROBINS, MONT C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MONT
Middle Name:C
Last Name:ROBINS
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:PO BOX 281221
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 N CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6590
Practice Address - Country:US
Practice Address - Phone:801-771-7700
Practice Address - Fax:801-771-7799
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59395211206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870653164002Medicaid
UT107004880101OtherIHC
Q48094Medicare UPIN
005575707Medicare ID - Type Unspecified
P00450248Medicare PIN
UT107004880101OtherIHC