Provider Demographics
NPI:1306498654
Name:ENTRINGER, JARRED J
Entity type:Individual
Prefix:
First Name:JARRED
Middle Name:J
Last Name:ENTRINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 700 E APT K
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2883
Mailing Address - Country:US
Mailing Address - Phone:605-261-8734
Mailing Address - Fax:
Practice Address - Street 1:2725 S 700 E APT K
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2883
Practice Address - Country:US
Practice Address - Phone:605-261-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11701615-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant