Provider Demographics
NPI:1578525200
Name:BAIRD, JONATHAN THOMAS (PA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:BAIRD
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Gender:M
Credentials:PA-C, ATC
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Mailing Address - Street 1:10433 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8502
Mailing Address - Country:US
Mailing Address - Phone:801-260-1919
Mailing Address - Fax:801-260-1441
Practice Address - Street 1:10433 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8502
Practice Address - Country:US
Practice Address - Phone:801-260-1919
Practice Address - Fax:801-260-1441
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6309270-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant