Provider Demographics
NPI:1881881183
Name:BECK, PHILLIP DARRELL (PA)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:DARRELL
Last Name:BECK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7611 S JORDAN LANDING BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5610
Mailing Address - Country:US
Mailing Address - Phone:801-260-1919
Mailing Address - Fax:
Practice Address - Street 1:7611 S JORDAN LANDING BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5610
Practice Address - Country:US
Practice Address - Phone:801-260-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295966-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00061535Medicare PIN