Provider Demographics
NPI:1194580852
Name:JORDAN VALLEY PEDIATRICS
Entity type:Organization
Organization Name:JORDAN VALLEY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAZEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:AIZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-557-7546
Mailing Address - Street 1:1561 W 7000 S STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3556
Mailing Address - Country:US
Mailing Address - Phone:801-569-8344
Mailing Address - Fax:801-569-9150
Practice Address - Street 1:1561 W 7000 S STE 202
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-569-8344
Practice Address - Fax:801-569-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty