Provider Demographics
NPI:1427038256
Name:BINDRUP, JED REED (MD)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:REED
Last Name:BINDRUP
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 1:11762 SO STATE ST
Mailing Address - Street 2:SUITE 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 SO STATE ST
Practice Address - Street 2:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT952886351205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG15588Medicare UPIN
UT000011665Medicare ID - Type Unspecified