Provider Demographics
NPI:1487944096
Name:JOHNSTUN, JARED ALAN (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ALAN
Last Name:JOHNSTUN
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 1:623 E FORT UNION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5529
Mailing Address - Country:US
Mailing Address - Phone:385-412-1660
Mailing Address - Fax:
Practice Address - Street 1:623 E FORT UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5529
Practice Address - Country:US
Practice Address - Phone:385-412-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8134352-1205207R00000X, 207RC0200X
390200000X
IL036.160773207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease