Provider Demographics
NPI:1164650289
Name:PIKUS, JARED JON (DO,)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:JON
Last Name:PIKUS
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W 1500 N
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-8900
Mailing Address - Country:US
Mailing Address - Phone:435-623-3200
Mailing Address - Fax:801-623-3265
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-7076
Practice Address - Country:US
Practice Address - Phone:801-754-3600
Practice Address - Fax:801-754-3322
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7747244-1204207Q00000X
IDO-0659208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1164650289Medicaid
ID20001358Medicare PIN