| Dr Jeremy Robert Chidester, MD | |
|
1309 W South Jordan Pkwy Ste 110, South Jordan, UT 84095-9014 | |
| (801) 839-5557 | |
| (801) 770-4455 |
| Full Name | Dr Jeremy Robert Chidester |
|---|---|
| Gender | Male |
| Speciality | Plastic Surgery |
| Location | 1309 W South Jordan Pkwy Ste 110, South Jordan, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194015693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2082S0105X | Plastic Surgery - Surgery Of The Hand | 10668647-1205 (Utah) | Secondary |
| 208200000X | Plastic Surgery | 10668647-1205 (Utah) | Primary |
| Entity Name | Ihc Health Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629260880 PECOS PAC ID: 1850209420 Enrollment ID: O20031105000079 |
| Entity Name | Ward Md Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1114378023 PECOS PAC ID: 4082976360 Enrollment ID: O20180326002904 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jeremy Robert Chidester, MD 1309 W South Jordan Pkwy Ste 110, South Jordan, UT 84095-9014 Ph: (801) 839-5557 | Dr Jeremy Robert Chidester, MD 1309 W South Jordan Pkwy Ste 110, South Jordan, UT 84095-9014 Ph: (801) 839-5557 |
Dr. Grant Andreas Fairbanks, MD Plastic Surgery Medicare: Not Enrolled in Medicare Practice Location: 10382 S Jordan Gtwy Ste 100, South Jordan, UT 84095 Phone: 801-951-8099 Fax: 801-951-8098 | |
Makayla Nelson, Plastic Surgery Medicare: Not Enrolled in Medicare Practice Location: 5126 W Daybreak Pkwy, South Jordan, UT 84009 Phone: 801-213-5200 | |
Rylee Faye Woodward, LME Plastic Surgery Medicare: Not Enrolled in Medicare Practice Location: 5126 W Daybreak Pkwy, South Jordan, UT 84009 Phone: 801-213-4500 | |
Dr. Bryan Vern Sonntag, MD Plastic Surgery Medicare: Not Enrolled in Medicare Practice Location: 10437 S Jordan Gtwy, South Jordan, UT 84095 Phone: 801-571-7710 Fax: 801-571-7738 |