MEDICARE: JARRED J ENTRINGER

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	363A00000X	Physician Assistant	11701615-1206	UT

General Provider Information

NPI Number	:	1306498654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARRED J ENTRINGER

Provider Business Mailing Address
First Line	:	2725 S 700 E APT K
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2883
Country	:	US
Telephone Number	:	605-261-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 S 700 E APT K
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2883
Country	:	US
Telephone Number	:	605-261-8734
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	10/25/2021

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Directions to “ JARRED J ENTRINGER ” Practice Location

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