MEDICARE: DR. JONATHAN R WHISENANT 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	207RH0003X	Hematology & Oncology Physician	5948529-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00245904	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107039462101	OTHER	UT	SELECT HEALTH

General Provider Information

NPI Number	:	1861441974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN R WHISENANT MD

Provider Business Mailing Address
First Line	:	127 S 500 E STE 600
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1971
Country	:	US
Telephone Number	:	801-587-6705
Fax Number	:	801-715-8228

Provider Business Practice Location Address
First Line	:	1950 CIRCLE OF HOPE
Second Line	:	CLINIC 1A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-585-0100
Fax Number	:	801-585-7902

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/21/2022

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