Provider Demographics
NPI:1861637225
Name:RINARD, JEREMY RONALD (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:RONALD
Last Name:RINARD
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-4750
Mailing Address - Fax:
Practice Address - Street 1:4300 HARRISON BLVD
Practice Address - Street 2:SUITE 3855
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3186
Practice Address - Country:US
Practice Address - Phone:801-387-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54236208200000X
UT7850850-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00928882OtherMEDICARE RAILROAD
UTP00928882OtherMEDICARE RAILROAD