Healthcare Provider Details

I. General information

NPI: 1598056798
Provider Name (Legal Business Name): JARED COLE BUMGARDNER A.U.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1034 N 500 W
PROVO UT
84604-3380
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7348
  • Fax:
Mailing address:
  • Phone: 801-357-7448
  • Fax: 801-357-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7759335-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: