Provider Demographics
NPI:1831472679
Name:BENNETT, COLTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:COLTON
Middle Name:
Last Name:BENNETT
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 1:652 S MEDICAL CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7017
Mailing Address - Country:US
Mailing Address - Phone:435-251-2650
Mailing Address - Fax:435-251-2668
Practice Address - Street 1:652 S MEDICAL CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7017
Practice Address - Country:US
Practice Address - Phone:435-251-2650
Practice Address - Fax:435-251-2668
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8109348-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant