Individual
DR. ANDREA JENSEN MATICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
96 E KIMBALLS LN STE 207, DRAPER, UT 84020-5021
(801) 576-2300
(844) 249-1746
Mailing address
PO BOX 100253, ATLANTA, GA 30384-0253
(801) 568-5972
(844) 249-1746
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
6354383-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265638357
—
UT
Enumeration date
09/21/2007
Last updated
01/20/2020
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