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NPI Code Detail

MEDICARE: ZACHARY R. JERGENSEN MD

MEDICARE: ZACHARY R. JERGENSEN 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
1207L00000XAnesthesiology Physician2018020285MO
2207L00000XAnesthesiology Physician2020029411MO
3207LP2900XPain Medicine (Anesthesiology) Physician12751738-1205UT
4207L00000XAnesthesiology Physician12751738-1205UT

General Provider Information

NPI Number : 1023502093
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY R. JERGENSEN MD
Provider Business Mailing Address
First Line : 615 S ARAPEEN DR STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1239
Country : US
Telephone Number : 801-581-6393
Fax Number :
Provider Business Practice Location Address
First Line : 615 S ARAPEEN DR STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1239
Country : US
Telephone Number : 801-581-6393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 08/12/2022

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