Provider Demographics
NPI:1881790095
Name:BUTCHER, AARON (PA-C)
Entity type:Individual
Prefix:PROF
First Name:AARON
Middle Name:
Last Name:BUTCHER
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 1:1660 W ANTELOPE DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1167
Mailing Address - Country:US
Mailing Address - Phone:801-479-0312
Mailing Address - Fax:801-479-3364
Practice Address - Street 1:3080 N 1700 E STE B
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8592
Practice Address - Country:US
Practice Address - Phone:801-825-6597
Practice Address - Fax:888-770-2983
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV682363AS0400X
UTPA03172083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881790095Medicaid
NVP89819Medicare UPIN
NV1881790095Medicaid