Basic Information
| Provider Information | |||||||||
| NPI: | 1275909418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUPAIX | ||||||||
| FirstName: | CHARLES | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUND VALLEY DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356556600 | ||||||||
| FaxNumber: | 4356552388 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 ROUND VALLEY DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356556600 | ||||||||
| FaxNumber: | 4356552388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 9852475-8906 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 003467 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.