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Individual
JEFFREY M WALLENTINE
Active
Individual
JEFFREY M WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
356423-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-00180
UTAH HEALTHCARE
UT
01
—
107008449102
IHC
UT
01
—
200045124
PALMETTO
UT
01
—
344490
DMBA
UT
01
—
68080
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028WAL
EMIA
UT
01
—
QM000056640
ALTIUS
UT
Enumeration date
09/07/2006
Last updated
11/27/2023
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