Provider Demographics
NPI:1699401943
Name:DISCOE, MARA RACHEL RABIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:RACHEL RABIN
Last Name:DISCOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:RACHEL RABIN
Other - Last Name:DISCOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MARA DISCOE, PA-C
Mailing Address - Street 1:2200 PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7246
Mailing Address - Country:US
Mailing Address - Phone:435-615-8822
Mailing Address - Fax:435-615-8823
Practice Address - Street 1:2200 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7246
Practice Address - Country:US
Practice Address - Phone:435-615-8822
Practice Address - Fax:435-615-8823
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12945855-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant