Healthcare Provider Details

I. General information

NPI: 1033503495
Provider Name (Legal Business Name): JONATHAN DOUGLAS MAYEUX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

7533 S CENTER VIEW CT STE R
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4800
  • Fax:
Mailing address:
  • Phone: 801-432-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.70129840
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21680
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13052767-8905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: