Individual
TROY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA.C
Contact information
Practice address
1820 SIDEWINDER DR, PARK CITY, UT 84060-7492
(435) 655-6600
Mailing address
1820 SIDEWINDER DR, PARK CITY, UT 84060-7492
(435) 655-6600
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
379295-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107033706101
SELECTHEALTH
UT
01
—
231831
ALTIUS HEALTH PLANS
UT
01
—
80922
PUBLIC EMPLOYEES HEALTH P
UT
01
—
841433992TRY
EDUCATORS MUTUAL
UT
Enumeration date
08/03/2006
Last updated
03/08/2010
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