Provider Demographics
NPI:1174797757
Name:DAY, GORDON LYNN (PA-C)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:LYNN
Last Name:DAY
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 1:9665 S 1835 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3072
Mailing Address - Country:US
Mailing Address - Phone:801-879-3331
Mailing Address - Fax:801-576-4285
Practice Address - Street 1:9665 S 1835 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-3072
Practice Address - Country:US
Practice Address - Phone:801-879-3331
Practice Address - Fax:801-576-4285
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142502-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant