Provider Demographics
NPI:1366421596
Name:JARRETT, ARLEN K (MD)
Entity type:Individual
Prefix:
First Name:ARLEN
Middle Name:K
Last Name:JARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 W 9000 S
Mailing Address - Street 2:#210
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8876
Mailing Address - Country:US
Mailing Address - Phone:801-569-2626
Mailing Address - Fax:801-569-5333
Practice Address - Street 1:3570 W 9000 S
Practice Address - Street 2:#210
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8876
Practice Address - Country:US
Practice Address - Phone:801-569-2626
Practice Address - Fax:801-569-5333
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170386-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000000182Medicare ID - Type Unspecified
UTD07244Medicare UPIN