SCOTT BRUDERER (NPI# 1003988205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003988205 |
| Entity Type | Individual |
| Full Name | SCOTT BRUDERER |
| Credential | PA |
| Practice Address |
96 E Kimballs Ln Ste 207 Draper UT 84020-5021 |
| Mailing Address |
Po Box 100253 Atlanta GA 30384-1221 |
| Practice Telephone | 8015762300 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-01-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2828151206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
96 E KIMBALLS LN STE 207 |
| City | DRAPER |
| State | UT |
| Zip Code | 84020-5021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447204821 | Stuart C Marshall Jr. | Orthopaedic Surgery | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2006-05-20 |
| 1932458619 | David Gerald Tranter | Physician Assistant | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2012-09-10 |
| 1841517257 | Spencer Hayden Amundsen | Orthopaedic Surgery | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2010-04-24 |
| 1902092133 | Andrea Jensen Matich | Family Medicine | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2007-09-21 |
| 1992923874 | Richard Brian Mackey | Orthopaedic Surgery | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2007-04-23 |
| 1144369935 | Traske Mcneil Muir | Orthopaedic Surgery | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2007-02-06 |
| 1770635245 | Robert William Townsley | Physician Assistant | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2007-01-17 |
| 1528124815 | Charles L. Beck Jr. | Orthopaedic Surgery | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2006-12-29 |
| 1447329164 | Patrick Barnes | Physician Assistant | 96 E Kimballs Ln Ste 207, Draper, UT 84020-5021 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322776 | Chase Larsen Dmd Pllc | Dentist | 723 E 12200 S, Draper, UT 84020 | 2020-10-06 |
| 1780222380 | Derek Cragun | Counselor | 11706 700 E, Draper, UT 84020 | 2019-12-13 |
| 1720629371 | Own My Health Medical | Clinic/Center | 12371 900 E, Suite 102, Draper, UT 84020 | 2019-10-04 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1124670872 | Necia Dalley | Registered Nurse | 11800 S State St, Draper, UT 84020 | 2019-07-12 |
| 1285100784 | Tracey M Williams | Psychologist | 13200 S 1601 E, Draper, UT 84020 | 2018-10-23 |
| 1275008328 | Amoni Paeahelotu Finau | Community Health Worker | 13703 Wheatfield Way, Draper, UT 84020 | 2018-10-04 |
| 1891275525 | Cynthia Mae Bolton | Psychologist | 1192 E Draper Parkway # 447, Draper, UT 84020 | 2018-08-21 |
| 1164908026 | Headin' Home Inc. | Community/Behavioral Health | 12300 S. 150 W., Draper, UT 84020 | 2018-07-13 |
| 1366932576 | Forest Hulet | Dentist | 219 E 12300, Ste I-5, Draper, UT 84020 | 2018-05-14 |
| Find all providers in zip 84020 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194379040 | Tyson Wilcox | Physician Assistant | 11593 S Douglas Vista Dr, Draper, UT 84020-1480 | 2019-07-30 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1336610450 | Cory Michael Rice | Physician Assistant | 12176 S 1000 E Ste 4, Draper, UT 84020-3221 | 2018-12-16 |
| 1366917270 | Trevor Apple | Physician Assistant | 11432 S Loganberry Ct, Draper, UT 84020-9477 | 2018-10-06 |
| 1861852527 | Heidi Johnson | Physician Assistant | 11724 S State St, Draper, UT 84020-7163 | 2016-02-24 |
| 1922481696 | John Hooley | Physician Assistant | 224 E Spencer Peak Way Unit F4, Draper, UT 84020-6956 | 2015-06-30 |
| 1720414204 | Sarah Cookler | Physician Assistant | 1126 E Draper Pkwy, Draper, UT 84020-9095 | 2013-09-17 |
| 1568700375 | Kent Ma | Physician Assistant | 233 W Beverlee Ann Dr, Draper, UT 84020-6875 | 2013-01-29 |
| 1295970515 | Stephanie Boulter | Physician Assistant | 1624 E Cypress Point Way, Draper, UT 84020-8808 | 2008-12-16 |
| 1225288376 | Jennifer Holt Johnson | Physician Assistant | 74 E 11800 S Ste 360, Draper, UT 84020-5006 | 2008-09-25 |
| Find all providers in DRAPER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.