Provider Demographics
NPI:1982869210
Name:TAYLOR, SCOTT D (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:TAYLOR
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 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:801-284-1755
Mailing Address - Fax:801-262-3897
Practice Address - Street 1:5323 WOODROW ST STE 102
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5853
Practice Address - Country:US
Practice Address - Phone:801-284-1755
Practice Address - Fax:801-262-3897
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTPENDING363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical