Provider Demographics
NPI:1285169714
Name:MATHIEU, JEANNETTE (MD)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 S STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4812
Mailing Address - Country:US
Mailing Address - Phone:540-533-3427
Mailing Address - Fax:
Practice Address - Street 1:5169 S COTTONWOOD ST STE 303
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER ECCLES OUTPATIENT CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6768
Practice Address - Country:US
Practice Address - Phone:801-507-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13276869-12052085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology