Provider Demographics
NPI:1730871633
Name:DUFFIN, JAYSON (PA)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:DUFFIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:385-666-9600
Mailing Address - Fax:385-666-9601
Practice Address - Street 1:691 E 400 N STE 110
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-7509
Practice Address - Country:US
Practice Address - Phone:385-666-9600
Practice Address - Fax:385-666-9601
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13556820-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty