Individual
DR. JASON ANTHONY KIRKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1433 N 1075 W STE 104, FARMINGTON, UT 84025-2746
(801) 298-1300
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5827923-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505947
—
NV
05
—
120831400
—
WY
01
—
58279231200001
BCBSUT
UT
01
—
58279231203001
BCBSUT
UT
05
—
807205500
—
ID
05
—
D6039
—
UT
01
—
P00224687
RR MEDICARE
UT
01
—
P00651539
RR MEDICARE
UT
Enumeration date
07/15/2005
Last updated
02/26/2019
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