Provider Demographics
NPI:1083721765
Name:MOODALAGIRIAPPA, JAYAPRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYAPRAKASH
Middle Name:
Last Name:MOODALAGIRIAPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-432-2668
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT74-156806-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT37806OtherPEHP
UT35683OtherDESERET MUTUAL
ID002999200Medicaid
UT107005021101OtherIHC
UT8597445OtherWORKERS COMP FUND
UTQM0000075886OtherALTIUS
NV002085089Medicaid
UT1502954OtherUMWA
AZ857394Medicaid
UTPRA02897OtherMOLINA
UT2090168OtherUNITED HEALTHCARE
WY107961100Medicaid
UT53245OtherHEALTHY U
UT870545614JA1OtherEDUCATORS MUTUAL
UT8597445OtherWORKERS COMP FUND
UTQM0000075886OtherALTIUS
UT1502954OtherUMWA