Provider Demographics
NPI:1992339485
Name:QUERTINMONT, JOSHUA MARTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARTIN
Last Name:QUERTINMONT
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 1:1950 CIRCLE OF HOPE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5500
Mailing Address - Country:US
Mailing Address - Phone:801-587-4644
Mailing Address - Fax:801-587-4169
Practice Address - Street 1:1950 CIRCLE OF HOPE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5500
Practice Address - Country:US
Practice Address - Phone:018-587-4644
Practice Address - Fax:801-587-4169
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13077860-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical