Provider Demographics
NPI:1720264237
Name:MOUNTFORD, ROBIN A (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:MOUNTFORD
Suffix:
Gender:F
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 1:1756 WEST PARK AVE.
Mailing Address - Street 2:RIVERTON FAMILY HEALTH CENTER
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4701
Mailing Address - Country:US
Mailing Address - Phone:801-254-0309
Mailing Address - Fax:801-253-1012
Practice Address - Street 1:1756 W. PARK AVE.
Practice Address - Street 2:RIVERTON FAMILY HEALTH CENTER
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4701
Practice Address - Country:US
Practice Address - Phone:801-254-0309
Practice Address - Fax:801-253-1012
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6779916-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1720264237OtherNPI