Provider Demographics
NPI:1598910101
Name:FRANCOM, MATT SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:SCOTT
Last Name:FRANCOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3489
Practice Address - Street 1:2973 W 125 S
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:801-475-3960
Practice Address - Fax:801-475-3961
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2945431206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000106068OtherMEDICARE PART B