# JUPITER MEDICAL I LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104346543
- **Authorized official:** MR. BRYAN KNEPPER (OWNER)
- **Authorized official phone:** (617) 571-3680

## Contact information

- **Practice address:** 1784 UINTA WAY UNIT E2, PARK CITY, UT 84098-7685
- **Practice address phone:** (435) 604-0160
- **Practice address fax:** (435) 731-8328
- **Mailing address:** 21 WHITE HILL RD, COLD SPRING HARBOR, NY 11724-1211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | UT | Yes |

## Other

- **Enumeration date:** 06/27/2017
- **Last updated:** 06/27/2017