Provider Demographics
NPI:1457666562
Name:HEATON, JARED (DO)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:HEATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 500 S STE 210
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7254
Mailing Address - Country:US
Mailing Address - Phone:801-797-9121
Mailing Address - Fax:801-797-9182
Practice Address - Street 1:434 E 5350 S STE D
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5417
Practice Address - Country:US
Practice Address - Phone:801-827-9100
Practice Address - Fax:385-264-0660
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9017921207N00000X, 207NI0002X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology