Provider Demographics
NPI:1295710960
Name:BINGHAM, RONALD SCOTT (PA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1580 W ANTELOPE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-773-8644
Mailing Address - Fax:801-927-1591
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:801-927-1591
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT214984-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical