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General NPI Number Information
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NPI Number | 1992440143
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Entity Type | Individual
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Provider Name | JONATHAN MITTON DO
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Gender | Male
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 3578 E PONY EXPRESS PKWY
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6088
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Country | US
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Telephone | 801-435-7980
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 E PONY EXPRESS PKWY
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6088
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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 |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R3764
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 8962266-1204
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License Number State | UT
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