Healthcare Provider Details

I. General information

NPI: 1447781356
Provider Name (Legal Business Name): ALEX SPENCER JEPSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0816
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR 3RD FLOOR NORTH
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7822
  • Fax: 801-585-9166
Mailing address:
  • Phone: 801-581-7822
  • Fax: 801-585-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7400747-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7400747-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: