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NPI Code Detail

MEDICARE: DR. JEREMY MCCANDLESS M.D.

MEDICARE: DR. JEREMY MCCANDLESS M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1174713424
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY MCCANDLESS M.D.
Provider Business Mailing Address
First Line : 475 W 940 N
Second Line :
City : PROVO
State : UT
Zip : 84604-3301
Country : US
Telephone Number : 801-357-7930
Fax Number : 801-357-7927
Provider Business Practice Location Address
First Line : 475 W 940 N
Second Line :
City : PROVO
State : UT
Zip : 84604-3301
Country : US
Telephone Number : 801-357-7930
Fax Number : 801-357-7927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 08/01/2007

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