Individual
JEREMY MICHAEL EATOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
395 W COUGAR BLVD STE 205, PROVO, UT 84604-3328
(801) 357-1770
(801) 357-1779
Mailing address
1215 W 1870 N, PROVO, UT 84604-5017
(801) 717-5958
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12478072-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/03/2021
Last updated
10/04/2021
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