Individual
JEREMY ROYLE STODDART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N 1900 E, UNIVERSITY HOSPITAL,, SLC, UT 84132
(801) 581-2121
Mailing address
7676 W LAMPLIGHTER ST, BOISE, ID 83714-2059
(801) 390-4618
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M-11897
ID
2084P0800X
Psychiatry Physician
MR-1166
ID
390200000X
Student in an Organized Health Care Education/Training Program
MR-1166
ID
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023242815
—
ID
Enumeration date
05/07/2009
Last updated
11/23/2021
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