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General NPI Number Information
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NPI Number | 1811962772
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Entity Type | Individual
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Provider Name | MICHAEL S JENNINGS MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 12/27/2009
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Provider Practice Location Address
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Address Line | 4525 WASATCH BLVD STE 310
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-4700
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Country | US
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Telephone | 801-998-8492
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Fax | 801-998-8489
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Provider Business Mailing Address
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Address Line | 4525 WASATCH BLVD STE 310
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-4700
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Country | US
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Telephone | 801-998-8492
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Fax | 801-998-8489
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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 | 2637851205
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License Number State | UT
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