Healthcare Provider Details

I. General information

NPI: 1386943611
Provider Name (Legal Business Name): JEFFREY B HORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEDICAL DRIVE
SALT LAKE CITY UT
84132
US

IV. Provider business mailing address

127 S 500 E STE. 600
SALT LAKE CITY UT
84102-1959
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 801-587-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU6870
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8436562-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: