Provider Demographics
NPI:1346396959
Name:MYERS, JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MYERS
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:UNIVERSITY OF UTAH DIVISION OF UROLOGY
Mailing Address - Street 2:30 N 1900 E, RM 3B420
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-213-2700
Mailing Address - Fax:801-585-2891
Practice Address - Street 1:UNIVERSITY OF UTAH DIVISION OF UROLOGY
Practice Address - Street 2:30 N 1900 E, RM 3B420
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-213-2700
Practice Address - Fax:801-585-2891
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7325424-1205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology