Provider Demographics
NPI:1720654486
Name:MONSEN, JAYMES BLAKE (CPHT)
Entity Type:Individual
Prefix:
First Name:JAYMES
Middle Name:BLAKE
Last Name:MONSEN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N UNIVERSITY AVE
Mailing Address - Street 2:PRIMARY CARE DEPARTMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2990
Mailing Address - Country:US
Mailing Address - Phone:801-213-3200
Mailing Address - Fax:801-213-6883
Practice Address - Street 1:165 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2990
Practice Address - Country:US
Practice Address - Phone:801-213-3200
Practice Address - Fax:801-213-6883
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10438198-1717208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology