Individual
MR. JERRY WILLIAM HUSSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
500 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1221
(801) 583-2787
(801) 584-5141
Mailing address
500 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1221
(801) 583-2787
(801) 584-5141
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
3403921205
UT
207ZH0000X
Hematology (Pathology) Physician
9291
NV
207ZH0000X
Hematology (Pathology) Physician
G86484
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
3403921205
UT
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
9291
NV
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
G86484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200225018
—
NV
Enumeration date
03/30/2006
Last updated
10/29/2013
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