Jill E Clark MD PC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

73799221205 Issued in UT

Legal business name

JILL E CLARK MD PC

Practice address

1220 E 3900 S
Ste 4I
Salt Lake City, UT 84124-1377

Phone

(801) 263-1621

Fax

(801) 263-1647

NPI assigned

Jan 26, 2010

Organization subpart

No

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

Authorized official

Name

Jill E Clark, MD

Title

President

Phone

(801) 263-1621

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264464000000",
    "number": "1922339373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S",
            "address_2": "STE 4I",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241377",
            "telephone_number": "801-263-1621",
            "fax_number": "801-263-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S",
            "address_2": "STE 4I",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241377",
            "telephone_number": "801-263-1621",
            "fax_number": "801-263-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JILL E CLARK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2010-01-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-263-1621",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "UT",
            "license": "73799221205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWNERS DOB",
            "identifier": "10281976",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saachi Jhandi
• Shefali N Jhaveri, MD
• Hina Jhawer
• Amanda Jiang
• Bill F Jiang
• Gregory Jimas
• Carleen S. Jimenez, LPC
• Elena Jimenez
• Isamar Jimenez, LCSW
• Jara Jimenez

• Colon & Rectal Surgery Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Colon & Rectal Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; 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.