Healthcare Provider Details

I. General information

NPI: 1225083504
Provider Name (Legal Business Name): JEFFREY J JUCHAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

IV. Provider business mailing address

811 E 1330 S
SPANISH FORK UT
84660-2988
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-380-0164
  • Fax: 888-313-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number277545-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: