Healthcare Provider Details

I. General information

NPI: 1902125032
Provider Name (Legal Business Name): JEREMY E THUESON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 400 E STE 259
BOUNTIFUL UT
84010-5095
US

IV. Provider business mailing address

450 S 400 E STE 259
BOUNTIFUL UT
84010-5095
US

V. Phone/Fax

Practice location:
  • Phone: 385-399-8787
  • Fax: 385-359-0808
Mailing address:
  • Phone: 385-399-8787
  • Fax: 385-359-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number9399527-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: