Individual
JAY TODD NILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10150 CENTENNIAL PKWY STE 230, SANDY, UT 84070-4123
(800) 594-5736
Mailing address
10150 CENTENNIAL PKWY STE 230, SANDY, UT 84070-4123
(800) 594-5736
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
366647-1205
UT
207L00000X
Anesthesiology Physician
G-83928
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107008628103
IHC
UT
01
—
190683600
US DEPT OF LABOR
UT
01
—
425650
DESERET MUTUAL
UT
01
—
66104
PEHP
UT
01
—
7151
HEALTHY U
UT
01
—
870666269JTN
EDUCATORS MUTUAL
UT
01
—
PRA02246
MOLINA
UT
01
—
QM0000054865
ALTIUS
UT
Enumeration date
09/16/2006
Last updated
01/27/2021
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