Provider Demographics
NPI:1912130311
Name:STRONG, ANDREW M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:STRONG
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 1:5444 S. GREEN ST.
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-284-1702
Mailing Address - Fax:801-262-3897
Practice Address - Street 1:5323 WOODROW ST STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5848
Practice Address - Country:US
Practice Address - Phone:801-713-0606
Practice Address - Fax:801-713-0609
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT744174-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical