MEDICARE: DR. OREN CLARON ALLDREDGE JR. 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
1	207W00000X	Ophthalmology Physician	155564-1205	UT

General Provider Information

NPI Number	:	1780685412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OREN CLARON ALLDREDGE JR. MD

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:	#140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-288-0067
Fax Number	:	801-288-0091

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:	#140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-288-0067
Fax Number	:	801-288-0091

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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