Provider Demographics
NPI:1255562690
Name:UINTA GENERAL SURGERY
Entity type:Organization
Organization Name:UINTA GENERAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:BRECK
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-789-8721
Mailing Address - Street 1:196 ARROWHEAD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-8752
Mailing Address - Country:US
Mailing Address - Phone:307-789-8721
Mailing Address - Fax:307-783-8664
Practice Address - Street 1:196 ARROWHEAD DR STE 4
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-8752
Practice Address - Country:US
Practice Address - Phone:307-789-8721
Practice Address - Fax:307-783-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL1200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty