MEDICARE: MR. JARED D ABRAMS PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1679836951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED D ABRAMS PA-C

Provider Business Mailing Address
First Line	:	5315 ADAMS AVE PKWY
Second Line	:	SUITE A
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-4766
Country	:	US
Telephone Number	:	801-476-4448
Fax Number	:	801-476-4449

Provider Business Practice Location Address
First Line	:	5315 ADAMS AVE PKWY
Second Line	:	SUITE A
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-4766
Country	:	US
Telephone Number	:	801-476-4448
Fax Number	:	801-476-4449

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	09/30/2015

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