Provider Demographics
NPI:1992973671
Name:W REED JAUSSI MD PC
Entity type:Organization
Organization Name:W REED JAUSSI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:REED
Authorized Official - Last Name:JAUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-752-2020
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:STE T
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2406
Mailing Address - Country:US
Mailing Address - Phone:435-752-0202
Mailing Address - Fax:435-752-5475
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:STE T
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-752-0202
Practice Address - Fax:435-752-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49198431205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03201958OtherOWNERSDOB