Individual
DR. MICHAEL JASON PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 581700, SALT LAKE CITY, UT 84158-1700
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5755109-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807539700
—
ID
01
—
P00343693
RAILROAD MEDICARE
UT
Enumeration date
05/20/2006
Last updated
11/11/2021
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