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General NPI Number Information
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NPI Number | 1114326709
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Entity Type | Organization
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Legal Business Name | JCD ENTERPRISES, LLC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 3352 W MERRYVALE CIR
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City | RIVERTON
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State | UT
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Zip | 84065-6045
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Country | US
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Telephone | 801-903-1122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 521593
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City | SALT LAKE CITY
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State | UT
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Zip | 84152-1593
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED DUNN
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Credential | MD
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Telephone | 801-419-5024
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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 | 9115648-0160
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License Number State | UT
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