Healthcare Provider Details

I. General information

NPI: 1639531650
Provider Name (Legal Business Name): BRADEN WOODHOUSE JEX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 110
VINEYARD UT
84059-7509
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-0246
  • Fax: 385-203-0245
Mailing address:
  • Phone: 435-215-0230
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13703732-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: