Provider Demographics
NPI:1437401932
Name:WIDEMAN, STEVEN JONES (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JONES
Last Name:WIDEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3590 HARRISON BLVD
Mailing Address - Street 2:#G-1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2060
Mailing Address - Country:US
Mailing Address - Phone:801-627-2122
Mailing Address - Fax:801-627-2125
Practice Address - Street 1:3590 HARRISON BLVD
Practice Address - Street 2:#G-1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2060
Practice Address - Country:US
Practice Address - Phone:801-627-2122
Practice Address - Fax:801-627-2125
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104209-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist