MEDICARE: JORDON LEBARON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841600996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDON LEBARON

Provider Business Mailing Address
First Line	:	1188 E RAYMOND RD
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 RAYMOND RD
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037-2252
Country	:	US
Telephone Number	:	801-698-6250
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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Directions to “ JORDON LEBARON ” Practice Location

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