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General NPI Number Information
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NPI Number | 1407280415
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Entity Type | Individual
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Provider Name | JOSEPH ANDREW REISTETTER MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 6550 S MILLROCK DR STE 250
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2331
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Country | US
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Telephone | 801-821-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 N TRIUMPH BLVD STE 500
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City | LEHI
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State | UT
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Zip | 84043-6475
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Country | US
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Telephone | 801-821-2333
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10964123-1205
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License Number State | UT
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