=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639531650
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADEN WOODHOUSE JEX D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2016
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 691 E 400 N STE 110
-----------------------------------------------------
City | VINEYARD
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84059-7509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-203-0246
-----------------------------------------------------
Fax | 385-203-0245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 912042
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84791-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-215-0230
-----------------------------------------------------
Fax | 435-986-7092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 13703732-1204
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------