Provider Demographics
NPI:1487677613
Name:NAISBITT, JED (MD)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:
Last Name:NAISBITT
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 1:1525 EAST 6000 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-337-5800
Mailing Address - Fax:801-337-5809
Practice Address - Street 1:1525 EAST 6000 SOUTH
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-337-5800
Practice Address - Fax:801-337-5809
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1734041205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT08197Medicaid
UT08197Medicaid