Provider Demographics
NPI:1689854861
Name:FAUSETT, AARON GREGORY (PA)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:GREGORY
Last Name:FAUSETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:336 W 100 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5881
Mailing Address - Country:US
Mailing Address - Phone:801-798-7301
Mailing Address - Fax:801-798-8513
Practice Address - Street 1:555 W STATE ROAD 164
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5732
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:801-465-3267
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7104965-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY125398100Medicaid
WY315589OtherBCBS WY
WYW21647Medicare PIN