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NPI Code Detail

MEDICARE: JENNIFER PAUL LEISER MD

MEDICARE: JENNIFER PAUL LEISER 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
1207Q00000XFamily Medicine Physician364970-1205UT

General Provider Information

NPI Number : 1851481469
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER PAUL LEISER MD
Provider Business Mailing Address
First Line : PO BOX 510004
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84151-0004
Country : US
Telephone Number : 801-213-3900
Fax Number :
Provider Business Practice Location Address
First Line : 1138 WILMINGTON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2819
Country : US
Telephone Number : 801-581-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 11/18/2021

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