Basic Information
| Provider Information | |||||||||
| NPI: | 1093155988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIATT | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | DON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1915 W 5950 S | ||||||||
| Address2: | |||||||||
| City: | ROY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840671454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013878100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MRO-1325 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 6210629-1204 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.