Provider Demographics
NPI:1609253962
Name:BOWERS, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11444 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7803
Mailing Address - Country:US
Mailing Address - Phone:801-253-5900
Mailing Address - Fax:801-253-5962
Practice Address - Street 1:11444 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7803
Practice Address - Country:US
Practice Address - Phone:801-253-5900
Practice Address - Fax:801-253-5962
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9317717-1206261QP2300X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care