Individual
MRS. JESSICA LAUREN MADERT HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3397 N 1200 E STE 103, LEHI, UT 84043-3262
(801) 797-0877
(801) 290-8141
Mailing address
3397 N 1200 E STE 103, LEHI, UT 84043-3262
(801) 797-0877
(801) 290-8141
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
8450572-1205
UT
208000000X
Pediatrics Physician
MD449593
PA
208D00000X
General Practice Physician
Primary
8450572-1205
UT
208D00000X
General Practice Physician
MD449593
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2983938
HIGHMARK BLUE SHIELD
PA
01
—
420536
UPMC
PA
Enumeration date
02/28/2007
Last updated
02/18/2022
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