MEDICARE: JORDAN BLAKE BUTTERFIELD DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	12247285-0501	UT

General Provider Information

NPI Number	:	1336638485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN BLAKE BUTTERFIELD DPM

Provider Business Mailing Address
First Line	:	4624 S HOLLADAY BLVD
Second Line	:	STE 201
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7168
Country	:	US
Telephone Number	:	801-889-3276
Fax Number	:	801-266-5633

Provider Business Practice Location Address
First Line	:	4624 S HOLLADAY BLVD STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7168
Country	:	US
Telephone Number	:	801-266-3113
Fax Number	:

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	04/08/2023

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