Provider Demographics
NPI:1699869479
Name:MACPHERSON, JANE ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:MACPHERSON
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 1:1121 E 3900 S STE C230
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1297
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-262-0507
Practice Address - Street 1:5131 S COTTONWOOD ST
Practice Address - Street 2:L-2
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-263-3416
Practice Address - Fax:801-263-3428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342206-1205207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00457716OtherRAILROAD MEDICARE
UTP00457716OtherRAILROAD MEDICARE
UT005744802Medicare PIN
UT000060230Medicare PIN
UT006986019Medicare PIN
UTP00457716OtherRAILROAD MEDICARE
UT000062281Medicare PIN
UT005586717Medicare PIN
UT005587616Medicare PIN
UT006985023Medicare PIN
UTE85084Medicare UPIN
UT000062413Medicare PIN
UT005569146Medicare PIN