Healthcare Provider Details

I. General information

NPI: 1437287851
Provider Name (Legal Business Name): EMILY JANE HAROLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 2100 S
SALT LAKE CITY UT
84119-1401
US

IV. Provider business mailing address

1525 W 2100 S
SALT LAKE CITY UT
84119-1401
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9900
  • Fax:
Mailing address:
  • Phone: 801-213-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberUT6019877-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: