Healthcare Provider Details

I. General information

NPI: 1487634960
Provider Name (Legal Business Name): DAVID PAUL JUBELIRER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 02/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 S FASHION BLVD SUITE 255
MURRAY UT
84107
US

IV. Provider business mailing address

6065 S FASHION BLVD SUITE 255
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-467-4210
  • Fax: 801-467-2702
Mailing address:
  • Phone: 801-467-2702
  • Fax: 801-467-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5755581-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: