Provider Demographics
NPI:1356514350
Name:TYSON, JARED JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:JOHN
Last Name:TYSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1551 RENAISSANCE TOWNE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7667
Mailing Address - Country:US
Mailing Address - Phone:801-295-7200
Mailing Address - Fax:801-295-4930
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-7200
Practice Address - Fax:801-295-4930
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8915908-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery