Basic Information
| Provider Information | |||||||||
| NPI: | 1528170750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAVOLDI | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9493 S 700 E | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840703459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015760176 | ||||||||
| FaxNumber: | 8015232657 | ||||||||
| Practice Location | |||||||||
| Address1: | 9493 S 700 E | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840703459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015760176 | ||||||||
| FaxNumber: | 8015232657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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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 | 207Q00000X | OP00001998 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 8064719-1204 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1121987 | 05 | WA | MEDICAID | 197142 | 01 | WA | DEPT. OF LABOR & IND. | OTHER |