David Maurice Blackwell PA-C

NPI 1184867574 - Physician Assistant - 363A00000X

NPI Details
NPI 1184867574
Gender Male
Enumeration Date 04/14/2009
Last Updated 07/02/2015
Entity Type Individual
Active Over 7 years ago
Practice Location
1055 N 500 W
SUITE 121
PROVO UT, 84604-3305, US
Phone (801) 373-7350
Fax (801) 812-5401
Business Location
1055 N 500 W
CREDENTIALING DEPARTMENT
PROVO UT, 84604-3305, US
Phone (801) 429-8000
Fax (801) 429-8150
Toxanomy
Taxonomy Code 363A00000X
License State Utah
License Number 5505835-1206
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According to our database, David Maurice Blackwell PA-C NPI is 1184867574, taxonomy code is 363A00000X and license number is 5505835-1206, license state is located at Utah. David Maurice Blackwell PA-C physically located at 1055 N 500 W, Provo UT, 84604-3305. NPI Number David Maurice Blackwell PA-C has the Individual type.

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1184867574 NPI number is provided on an as is basis without warranty of any kind. 1184867574 is maintained by the National Plan & Provider Enumeration System. The contents of David Maurice Blackwell PA-C are for informational purposes only.