MEDICARE: JEFFREY DRUCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	13012543-1205	UT

General Provider Information

NPI Number	:	1003925355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DRUCK MD

Provider Business Mailing Address
First Line	:	PO BOX 841450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-1450
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2545
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/08/2023

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