Healthcare Provider Details

I. General information

NPI: 1841346756
Provider Name (Legal Business Name): CHRISTOPHER JESSE JOLLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
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 Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number167833-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: