Provider Demographics
NPI:1851628218
Name:SERPICO, ROBERT ANDREW (PA-C, MSPAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANDREW
Last Name:SERPICO
Suffix:
Gender:M
Credentials:PA-C, MSPAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:924 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2045
Mailing Address - Country:US
Mailing Address - Phone:801-891-0896
Mailing Address - Fax:
Practice Address - Street 1:1375 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2658
Practice Address - Country:US
Practice Address - Phone:801-377-4745
Practice Address - Fax:801-373-5762
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7472700-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical