Provider Demographics
NPI:1265799308
Name:SCOVILLE, JAMES SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:SCOVILLE
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 1:1551 S. RENAISSANCE TOWNE DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-295-7200
Mailing Address - Fax:801-295-4930
Practice Address - Street 1:1551 S. RENAISSANCE TOWNE DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-295-7200
Practice Address - Fax:801-295-4930
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8134637-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant