Provider Demographics
NPI:1518402098
Name:SWINK, PHILIP JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:SWINK
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 1369
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-1369
Mailing Address - Country:US
Mailing Address - Phone:801-298-1300
Mailing Address - Fax:
Practice Address - Street 1:650 E 4500 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4536
Practice Address - Country:US
Practice Address - Phone:801-281-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9883370-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant