MEDICARE: DR. JON RANDAL YOUNG DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	104424-0501	UT
2	213ES0131X	Foot Surgery Podiatrist	104424-0501	UT

General Provider Information

NPI Number	:	1700816709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON RANDAL YOUNG DPM

Provider Business Mailing Address
First Line	:	4370 S. REDWOOD ROAD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2223
Country	:	US
Telephone Number	:	801-417-5386
Fax Number	:	801-417-5522

Provider Business Practice Location Address
First Line	:	4370 S. REDWOOD ROAD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2223
Country	:	US
Telephone Number	:	801-417-5386
Fax Number	:	801-417-5522

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/25/2022

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