Healthcare Provider Details

I. General information

NPI: 1639499783
Provider Name (Legal Business Name): JARED C MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LAYTON PKWY STE 4C
LAYTON UT
84041-3692
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3280
  • Fax: 801-475-3101
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5488876-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: