Provider Demographics
NPI:1083721880
Name:MULROY, JOHN J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MULROY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3707
Mailing Address - Country:US
Mailing Address - Phone:801-582-7725
Mailing Address - Fax:
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-3578
Practice Address - Fax:801-662-3579
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT187321-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005235101OtherIHC
UT870280408MU1OtherEDUCATORS MUTUAL
UTQM0000049532OtherALTIUS
WY100692400Medicaid
UT37700OtherPEHP
UT416943OtherDESERET MUTUAL
AZ706781Medicaid
UTPRA01271OtherMOLINA
ID002967200Medicaid
MT401765Medicaid
UT002085563OtherFIRST HEALTH
UT2000040OtherUNITED HEALTHCARE
UT2423OtherHEALTHY U
UT005512402Medicare ID - Type Unspecified
MT401765Medicaid