Individual
JODI SOUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(801) 587-5455
Mailing address
417 E 300 S APT 9, SALT LAKE CITY, UT 84111-2672
(202) 746-0089
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
7618740-1205
UT
207X00000X
Orthopaedic Surgery Physician
MT186754
PA
Other
Enumeration date
05/03/2007
Last updated
02/04/2022
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