Provider Demographics
NPI:1396789558
Name:JARRETT, ROSS M (PA)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:JARRETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-0150
Mailing Address - Country:US
Mailing Address - Phone:801-601-2825
Mailing Address - Fax:801-562-3169
Practice Address - Street 1:3336 PIONEER PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2000
Practice Address - Country:US
Practice Address - Phone:801-964-3925
Practice Address - Fax:801-964-3928
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263760-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396789558Medicaid
UT1396789558Medicaid