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General NPI Number Information
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NPI Number | 1912073966
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Entity Type | Organization
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Legal Business Name | KAYSVILLE FAMILY MEDICINE PC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 307 N 300 W STE 301
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City | KAYSVILLE
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State | UT
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Zip | 84037-1852
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Country | US
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Telephone | 801-543-2221
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Fax | 801-543-2249
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Provider Business Mailing Address
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Address Line | 307 N 300 W STE 301
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City | KAYSVILLE
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State | UT
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Zip | 84037-1852
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Country | US
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Telephone | 801-543-2221
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Fax | 801-543-2249
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN JARED POTTER
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Credential | MD
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Telephone | 801-543-2221
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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 | 57481181205
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License Number State | UT
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