Provider Demographics
NPI:1245557966
Name:JABEZ, JOSHUA VIJAYANAND (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:VIJAYANAND
Last Name:JABEZ
Suffix:
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 1:3127 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1238
Mailing Address - Country:US
Mailing Address - Phone:909-255-6840
Mailing Address - Fax:
Practice Address - Street 1:LDS HOSPITAL
Practice Address - Street 2:8TH AVE & C ST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015106662084P0800X
UT8134342-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry