Provider Demographics
NPI:1629077870
Name:NEWMAN, COREY L (PA-C)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:L
Last Name:NEWMAN
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 1:7611 S JORDAN LANDING BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5610
Mailing Address - Country:US
Mailing Address - Phone:801-260-1919
Mailing Address - Fax:801-260-1441
Practice Address - Street 1:7611 S JORDAN LANDING BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5610
Practice Address - Country:US
Practice Address - Phone:801-260-1919
Practice Address - Fax:801-260-1441
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372365-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS85867Medicare UPIN
UT005784406Medicare ID - Type Unspecified