Provider Demographics
NPI:1992718902
Name:MCBRIDE, JILL D (MD)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:D
Last Name:MCBRIDE
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 1:8211 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1851
Mailing Address - Country:US
Mailing Address - Phone:801-250-9638
Mailing Address - Fax:801-250-3204
Practice Address - Street 1:8211 W 3500 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1851
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-250-3204
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028551Medicaid
CAZZZ20177ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
CAGR0028551Medicaid