Individual
JEREMY BROADHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
190 S HIGHWAY 165, PROVIDENCE, UT 84332-9512
(435) 755-3300
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-7930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6681706-1204
UT
Other
Enumeration date
10/10/2007
Last updated
03/05/2012
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