Healthcare Provider Details

I. General information

NPI: 1699108225
Provider Name (Legal Business Name): E ALAN JEPPSEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 S 900 E SUITE 100
SALT LAKE CITY UT
84117-5788
US

IV. Provider business mailing address

PO BOX 27688
SALT LAKE CITY UT
84127-0688
US

V. Phone/Fax

Practice location:
  • Phone: 801-598-8228
  • Fax: 801-262-7567
Mailing address:
  • Phone: 801-534-1360
  • Fax: 801-366-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number149728-1205
License Number StateUT

VIII. Authorized Official

Name: DR. ERNERST ALAN JEPPSEN
Title or Position: DOCTOR
Credential: M.D.
Phone: 801-598-8228