Provider Demographics
NPI:1952459794
Name:FURUTA, DAVID LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:FURUTA
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 1:527 WASATCH WAY
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9238
Mailing Address - Country:US
Mailing Address - Phone:435-882-0322
Mailing Address - Fax:
Practice Address - Street 1:17800 CAMP WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4905
Practice Address - Country:US
Practice Address - Phone:810-878-5280
Practice Address - Fax:801-878-5144
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188545-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT65DOtherARMY NUMERICAL IDENTIFIER