Individual
MR. JASON PETER KIDDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2600
Mailing address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
016175
NY
363A00000X
Physician Assistant
Primary
9096169-1206
UT
Other
Enumeration date
10/17/2012
Last updated
02/07/2023
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