Provider Demographics
NPI:1508878372
Name:AGARWAL, JAYANT PRASAD
Entity Type:Individual
Prefix:
First Name:JAYANT
Middle Name:PRASAD
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF PLASTIC SURGERY ADMINISTRATIVE OFFICE
Mailing Address - Street 2:30 NORTH 1900 EAST 3B205
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-585-6839
Mailing Address - Fax:801-581-5794
Practice Address - Street 1:DIVISION OF PLASTIC SURGERY ADMINISTRATIVE OFFICE
Practice Address - Street 2:30 NORTH 1900 EAST 3B205
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-6839
Practice Address - Fax:801-581-5794
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA937682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery