MEDICARE: JEREMY KESSLER M.D.

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	207Q00000X	Family Medicine Physician	12910275-1205	UT

General Provider Information

NPI Number	:	1366705097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY KESSLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 741729
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-1729
Country	:	US
Telephone Number	:	801-771-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 E GORDON AVE STE 1
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2357
Country	:	US
Telephone Number	:	385-786-6100
Fax Number	:	385-786-6102

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	02/20/2025

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