Provider Demographics
NPI:1821080326
Name:VANDERHOOFT, J ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:J ERIC
Middle Name:
Last Name:VANDERHOOFT
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 1:1160 E 3900 S
Mailing Address - Street 2:#5000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1275
Mailing Address - Country:US
Mailing Address - Phone:801-262-8486
Mailing Address - Fax:801-284-8699
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:#5000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1275
Practice Address - Country:US
Practice Address - Phone:801-262-8486
Practice Address - Fax:801-284-8699
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2747311205207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0719Medicaid
UT005590502Medicare PIN
UTD0719Medicaid