Provider Demographics
NPI:1508801606
Name:HOUGAARD, JONI W (MD)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:W
Last Name:HOUGAARD
Suffix:
Gender:F
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:PO BOX 198560
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8846 S REDWOOD RD STE E121
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9366
Practice Address - Country:US
Practice Address - Phone:801-569-1999
Practice Address - Fax:801-569-2001
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT312402-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0238Medicaid
UT1164672770Medicaid
UTD0238Medicaid
UT000064932Medicare PIN
P00679718Medicare PIN
UT1164672770Medicaid