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Individual

JESSE NEIL SPENCER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
460 N MAIN ST, RICHFIELD, UT 84701-1836
(495) 896-5496
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-5300

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4795700-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1629206149
UT
Enumeration date
06/23/2009
Last updated
09/18/2012
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