Provider Demographics
NPI:1811929276
Name:BELOT, WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BELOT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 S FASHION BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6175
Mailing Address - Country:US
Mailing Address - Phone:801-314-4188
Mailing Address - Fax:801-314-4015
Practice Address - Street 1:370 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3184
Practice Address - Country:US
Practice Address - Phone:801-408-8700
Practice Address - Fax:801-408-8732
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3535441206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063162Medicare PIN
UTQ07041Medicare UPIN