Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 10668647-1205 | UT |
Y | 208600000X | Surgeon | 10668647-1205 | UT |
N | 2082S0105X | Plastic Hand Surgeon | 10668647-1205 | UT |
NPI | 1194015693 |
---|---|
Provider Name | Dr. Jeremy Robert Chidester |
First Address | Draper, UT 84020-7166 |
Second Address | Draper, UT 84020-7166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 29/04/2020 |