Individual
JED B VANDENBERGHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2180 E 4500 S, SALT LAKE CITY, UT 84117-4434
(801) 278-4693
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 278-4693
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
871778461205
UT
Other
Enumeration date
08/14/2006
Last updated
11/15/2007
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