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General NPI Number Information
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NPI Number | 1023095866
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Entity Type | Individual
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Provider Name | JAY CAESAR MORELAND M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/04/2011
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Provider Practice Location Address
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Address Line | 220 W 7200 S STE A 72ND STREET CLINIC, CHC INC
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City | MIDVALE
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State | UT
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Zip | 84047-1043
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Country | US
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Telephone | 801-566-5494
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Fax | 801-561-9647
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Provider Business Mailing Address
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Address Line | 220 W 7200 S STE A 72ND STREET CLINIC, CHC INC
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City | MIDVALE
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State | UT
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Zip | 84047-1043
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Country | US
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Telephone | 801-566-5494
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Fax | 801-561-9647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 263407-1205
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License Number State | UT
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