Organization
DERMATOLOGY CENTER OF SALT LAKE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH D JENSEN MD (MD/OWNER)
(801) 567-1400
Entity
Organization
Contact information
Practice address
7396 UNION PARK AVE, #201, MIDVALE, UT 84047-6700
(801) 567-1400
(801) 567-1777
Mailing address
7396 UNION PARK AVE, #201, MIDVALE, UT 84047-6700
(801) 567-1400
(801) 567-1777
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
266561-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007222102
IHC
—
05
—
528986681031
—
UT
01
—
52898668108001
BLUE SHIELD
UT
01
—
QM0000046926
ALTIUS
UT
Enumeration date
03/29/2006
Last updated
04/15/2019
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