Provider Demographics
NPI:1528170750
Name:SAVOLDI, JASON R (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:SAVOLDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9493 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3459
Mailing Address - Country:US
Mailing Address - Phone:801-576-0176
Mailing Address - Fax:801-523-2657
Practice Address - Street 1:9493 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3459
Practice Address - Country:US
Practice Address - Phone:801-576-0176
Practice Address - Fax:801-523-2657
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001998207Q00000X
UT8064719-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121987Medicaid
WA197142OtherDEPT. OF LABOR & IND.
WA1121987Medicaid
WAG8854417Medicare PIN