Provider Demographics
NPI:1639279573
Name:SPEAKMAN, JAMES JARED (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JARED
Last Name:SPEAKMAN
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 1:1490 E FOREMASTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4496
Mailing Address - Country:US
Mailing Address - Phone:435-628-1641
Mailing Address - Fax:435-628-1660
Practice Address - Street 1:1490 E FOREMASTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4496
Practice Address - Country:US
Practice Address - Phone:435-628-1641
Practice Address - Fax:435-628-1660
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3631331205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH63733Medicare UPIN
UT005539903Medicare ID - Type Unspecified