Healthcare Provider Details

I. General information

NPI: 1003751470
Provider Name (Legal Business Name): BRIGHAM DOUGLAS JEWKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10894 S RIVER FRONT PKWY
SOUTH JORDAN UT
84095-5609
US

IV. Provider business mailing address

416 E WHITE ROSE CIR
DRAPER UT
84020-8992
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-1200
  • Fax:
Mailing address:
  • Phone: 385-299-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: