Healthcare Provider Details

I. General information

NPI: 1003095506
Provider Name (Legal Business Name): CHRISTOPHER J. JOLLES MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12391 S 4000 W STE 208
RIVERTON UT
84096-7015
US

IV. Provider business mailing address

12391 S 4000 W STE 208
RIVERTON UT
84096-7015
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-5360
  • Fax: 801-302-7898
Mailing address:
  • Phone: 801-302-5360
  • Fax: 801-302-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number167833-1205
License Number StateUT

VIII. Authorized Official

Name: DR. CHRISTOPHER JESSE JOLLES
Title or Position: PRESIDENT
Credential: MD
Phone: 801-302-5360