Organization
JUPITER MEDICAL II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN KNEPPER (OWNER)
(617) 571-3680
Entity
Organization
Contact information
Practice address
7724 S 5600 W STE 102, WEST JORDAN, UT 84081-5415
(801) 432-8480
(435) 731-8328
Mailing address
21 WHITE HILL RD, COLD SPRING HARBOR, NY 11724-1211
(617) 571-3680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
U000092310
—
UT
Enumeration date
06/27/2017
Last updated
06/27/2017
Update your record
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