Provider Demographics
NPI:1336881408
Name:GOETZ, PHILLIP JAMES (PA-S)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:JAMES
Last Name:GOETZ
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:J
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PJ GOETZ
Mailing Address - Street 1:13142 S EAGLE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6969
Mailing Address - Country:US
Mailing Address - Phone:801-636-9608
Mailing Address - Fax:
Practice Address - Street 1:13142 S EAGLE PEAK DR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6969
Practice Address - Country:US
Practice Address - Phone:801-636-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program