Provider Demographics
NPI:1568669158
Name:GINOCCHIO, OWEN BENNETT (PA-C)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:BENNETT
Last Name:GINOCCHIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 N 1680 E
Mailing Address - Street 2:BLDG. W STE 105
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:801-616-2446
Mailing Address - Fax:435-355-3801
Practice Address - Street 1:230 N 1680 E
Practice Address - Street 2:BLDG. W STE 105
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:801-616-2446
Practice Address - Fax:435-355-3801
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6594276-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant