Provider Demographics
NPI:1477802825
Name:GREGORY, TONY SCOTT (PA)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:SCOTT
Last Name:GREGORY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12533 S 4260 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5504
Mailing Address - Country:US
Mailing Address - Phone:801-556-9357
Mailing Address - Fax:
Practice Address - Street 1:8446 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3501
Practice Address - Country:US
Practice Address - Phone:801-417-0131
Practice Address - Fax:801-255-5814
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8418422-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant