Healthcare Provider Details

I. General information

NPI: 1407200322
Provider Name (Legal Business Name): THOMAS LYLE GETHIN-JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHIPETA WAY DEPARTMENT OF PSYCHIATRY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

501 S CHIPETA WAY DEPARTMENT OF PSYCHIATRY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-8626
  • Fax:
Mailing address:
  • Phone: 801-587-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10484566-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: