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1982661344

NPI Code Detail

MEDICARE: JEAN F BOTHA MD

MEDICARE: JEAN F BOTHA 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	204F00000X	Transplant Surgery Physician	22313	NE
2	204F00000X	Transplant Surgery Physician	12742339-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982661344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN F BOTHA MD

Provider Business Mailing Address
First Line	:	5171 S COTTONWOOD ST STE 210
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5718
Country	:	US
Telephone Number	:	801-507-3380
Fax Number	:	385-297-2048

Provider Business Practice Location Address
First Line	:	5171 S COTTONWOOD ST STE 210
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5718
Country	:	US
Telephone Number	:	801-507-3380
Fax Number	:	385-297-2048

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	03/28/2022

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Directions to “ JEAN F BOTHA MD” Practice Location

Language	Start Address	Practice Location

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