Provider Demographics
NPI:1235299561
Name:RODNEY M. JEX DPM
Entity Type:Organization
Organization Name:RODNEY M. JEX DPM
Other - Org Name:DR.RODNEY M. JEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-292-9222
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:STE 215
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-292-9222
Mailing Address - Fax:801-298-3987
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:STE 215
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-292-9222
Practice Address - Fax:801-298-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22-102019-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529589232015Medicaid
UT529589232015Medicaid