Provider Demographics
NPI:1134701253
Name:LADLE, JIM (PA-C)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:LADLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 W CURRENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7965
Mailing Address - Country:US
Mailing Address - Phone:801-842-4097
Mailing Address - Fax:
Practice Address - Street 1:3022 W CURRENT CREEK DR STE A
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7965
Practice Address - Country:US
Practice Address - Phone:801-842-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program