Basic Information
| Provider Information | |||||||||
| NPI: | 1063627859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADSEN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 634 W 800 S | ||||||||
| Address2: | |||||||||
| City: | ALPINE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840041513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016166695 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 750 W 800 N | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017146570 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 333118-8905 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00434278 | 01 | UT | RAIL ROAD | OTHER | 33311820500001 | 01 | UT | BLUE CROSS BLUE SHIELD | OTHER |