Provider Demographics
NPI:1407002553
Name:JED R BINDRUP MD PC
Entity Type:Organization
Organization Name:JED R BINDRUP MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BINDRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-316-1313
Mailing Address - Street 1:11762 S STATE ST
Mailing Address - Street 2:STE 260
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7156
Mailing Address - Country:US
Mailing Address - Phone:801-316-1313
Mailing Address - Fax:801-316-1314
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:STE 260
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7156
Practice Address - Country:US
Practice Address - Phone:801-316-1313
Practice Address - Fax:801-316-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288635-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528231229000Medicaid
UT528231229000Medicaid