NPIMap

Organization Active NPI

Jerry Chidester MD PLLC

  • Clinic/Center
  • Draper, UT
National Provider Identifier
1558983775
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JERRY CHIDESTER MD PLLC
Practice address
11762 S State St Ste 333
Draper, UT 84020-7166
Phone
(801) 839-5557
NPI assigned
May 11, 2020
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Jeremy Robert Chidester, MDNPI 1194015693
Title
Plastic Surgeon
Phone
(801) 839-5557

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

11762 S State St Ste 333
Draper, UT 84020-7166

Mailing address

11762 S State St Ste 333
Draper, UT 84020-7166
Phone (801) 839-5557

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1558983775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 333",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-839-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 333",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-839-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY CHIDESTER MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "CHIDESTER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PLASTIC SURGEON",
        "authorized_official_telephone_number": "801-839-5557",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.