Individual
JEREMY WALLENTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2913 GARDEN MEADOWS CV, SLC, UT 84106-1302
(801) 865-2442
Mailing address
2913 GARDEN MEADOWS CV, SLC, UT 84106-1302
(801) 865-2442
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
3289491205
UT
Other
Enumeration date
07/07/2008
Last updated
11/09/2011
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