MEDICARE: JARED C DUNN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	52129531205	UT
2	207PS0010X	Sports Medicine (Emergency Medicine) Physician	5212953-1205	UT

General Provider Information

NPI Number	:	1003823808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED C DUNN MD

Provider Business Mailing Address
First Line	:	5848 S FASHION BLVD STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6121
Country	:	US
Telephone Number	:	801-314-4020
Fax Number	:	801-314-4015

Provider Business Practice Location Address
First Line	:	5848 S FASHION BLVD STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6121
Country	:	US
Telephone Number	:	801-314-4020
Fax Number	:	801-314-4015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	10/14/2014

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