Jack D Wahlen, M.D.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

791639051205 Issued in UT

Practice address

4403 Harrison Blvd
Ste 3630
Ogden, UT 84403-3271

Phone

(801) 387-7900

Fax

(801) 387-7910

NPI assigned

Jul 10, 2006

Last updated

Feb 26, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203984000000",
    "number": "1033143508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-387-7900",
            "fax_number": "801-387-7910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "STE 3630",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-387-7900",
            "fax_number": "801-387-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLEN",
        "first_name": "JACK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "UT",
            "license": "791639051205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jocelyn Vranes
• Elizabeth Wade
• Charlotte Erin Wagner, RPH
• Jessika Wagner, MD
• Jessica Susan Wagstaff, LAT, ATC
• Russell S. Wahlen, D.C.
• Norman O Wahlstrom Jr., MD
• Lara Waite, AUD
• Wake Up Sense LLC (Wake Up Sense Holistic Healing)
• Wal-Mart

• Endocrinology, Diabetes & Metabolism Physician in Ogden, UT
• Providers in Ogden, UT by specialty
• Endocrinology, Diabetes & Metabolism Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.