Healthcare Provider Details

I. General information

NPI: 1164650289
Provider Name (Legal Business Name): JARED JON PIKUS DO,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST
SANTAQUIN UT
84655-7076
US

IV. Provider business mailing address

48 W 1500 N
NEPHI UT
84648-8900
US

V. Phone/Fax

Practice location:
  • Phone: 801-754-3600
  • Fax: 801-754-3322
Mailing address:
  • Phone: 435-623-3200
  • Fax: 801-623-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7747244-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: