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Individual

JEFFREY R VANBLARCOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3645
Mailing address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3645

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5698653-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
H01800
UT
Enumeration date
11/03/2006
Last updated
11/23/2021
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