Healthcare Provider Details

I. General information

NPI: 1396332292
Provider Name (Legal Business Name): JEFFREY MAC MCNAUGHTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

139 E MONTGOMERY LN
NORTH OGDEN UT
84414-7099
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7606
  • Fax:
Mailing address:
  • Phone: 580-554-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR80030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: