Provider Demographics
NPI:1821097205
Name:PINGREE, JAMES HAZEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HAZEN
Last Name:PINGREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:166 E 5900 S
Mailing Address - Street 2:B-103
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7257
Mailing Address - Country:US
Mailing Address - Phone:801-262-3395
Mailing Address - Fax:801-262-3396
Practice Address - Street 1:166 E 5900 S
Practice Address - Street 2:B-103
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7257
Practice Address - Country:US
Practice Address - Phone:801-262-3395
Practice Address - Fax:801-262-3396
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT03658208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63787Medicare UPIN