Unknown Individual – Pediatric Adolescent Medicine Physician, NPI 1396839403
Pediatric Adolescent Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1268, West South Jordan Parkway, Chattel Number 5, South Jordan, Salt Lake County, Utah, 84095, United States
STE 201
SOUTH JORDAN, UT 840954652
Phone: (801) 254-9700
Fax: (801) 254-9755
Type: Location
2090, East Genova Drive 11980 South, Draper Oaks, Draper, Salt Lake County, Utah, 84020, United States
DRAPER, UT 840206107
Phone: (801) 495-0735
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84095)
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