Healthcare Provider Details

I. General information

NPI: 1891976783
Provider Name (Legal Business Name): JASON HARPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4088 N HIGHWAY 91
HYDE PARK UT
84318-4125
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-563-4900
  • Fax: 435-563-4952
Mailing address:
  • Phone: 435-563-4900
  • Fax: 435-563-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO201345
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4794632-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: