Provider Demographics
NPI:1891997045
Name:JEPHSON, JAMES LYNN
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNN
Last Name:JEPHSON
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 1:3285 SOUTH 5063 WEST
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120
Mailing Address - Country:US
Mailing Address - Phone:801-965-0527
Mailing Address - Fax:801-965-0527
Practice Address - Street 1:3285 SOUTH 5063 WEST
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-965-0527
Practice Address - Fax:801-965-0527
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist