Provider Demographics
NPI:1851587133
Name:REMINGTON, TRAVIS MARK (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MARK
Last Name:REMINGTON
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5169 COTTONWOOD ST
Mailing Address - Street 2:SUITE# 410
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-1650
Mailing Address - Fax:801-507-1625
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:SUITE# 410
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-1650
Practice Address - Fax:801-507-1625
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4859842-1206363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical