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NPI Code Detail

MEDICARE: TYSON R. JERGENSEN MD

MEDICARE: TYSON 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
1207LP2900XPain Medicine (Anesthesiology) Physician12404285-1205UT

General Provider Information

NPI Number : 1366071227
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSON R. JERGENSEN MD
Provider Business Mailing Address
First Line : PO BOX 337
Second Line :
City : LAYTON
State : UT
Zip : 84041-0337
Country : US
Telephone Number : 801-773-4840
Fax Number :
Provider Business Practice Location Address
First Line : 50 N MEDICAL DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-581-3622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2020
Last Update Date : 05/18/2026

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Directions to “ TYSON R. JERGENSEN MD” Practice Location

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