Healthcare Provider Details

I. General information

NPI: 1588289649
Provider Name (Legal Business Name): JENNIFERLYN MCGORTY DROLL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L MCGORTY DPM

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 600 S STE 408
HEBER CITY UT
84032-2286
US

IV. Provider business mailing address

PO BOX 849795
LOS ANGELES CA
90084-9795
US

V. Phone/Fax

Practice location:
  • Phone: 801-441-4191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number970
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number14280437-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: