1639365034 NPI number — UTAH COUNTY MEDICAL ASSOCIATES, LLC

Table of content: DR. JEFFREY LOUIS EVRA D.D.S. (NPI 1477679256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639365034 NPI number — UTAH COUNTY MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH COUNTY MEDICAL ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639365034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
269 E 400 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84663-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-491-9883
Provider Business Mailing Address Fax Number:
801-489-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 E 400 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84663-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-491-9883
Provider Business Practice Location Address Fax Number:
801-489-3141
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILDE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MARSHAL
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
801-465-4896

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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