Organization
JERRY CHIDESTER MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY ROBERT CHIDESTER MD (PLASTIC SURGEON)
(801) 839-5557
Entity
Organization
Contact information
Practice address
11762 S STATE ST STE 333, DRAPER, UT 84020-7166
(801) 839-5557
Mailing address
11762 S STATE ST STE 333, DRAPER, UT 84020-7166
(801) 839-5557
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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