NPI 1114115664

Jeremy Broadhurst, DO

Practitioner Family Medicine Physician Providence, UT

Practice location

Address: 190 S Highway 165, Providence, UT 84332-9512
Phone: (435) 755-3300
Mailing address: PO Box 27128, Salt Lake City, UT 84127-0128

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence 6681706-1204 (UT)

Other Family Medicine providers in Utah →

Registry record

NPI: 1114115664
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Oct 2007
Record last updated: 5 Mar 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.