Provider Demographics
NPI:1043312952
Name:OSTERSTOCK, JAN (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:OSTERSTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1910
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:359 - 8TH AVENUE
Practice Address - Street 2:ASC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103
Practice Address - Country:US
Practice Address - Phone:801-408-3200
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85-172584-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT14706OtherPEHP
UT2090168OtherUNITED HEALTHCARE
AZ822222Medicaid
UT870545614OS1OtherEDUCATORS MUTUAL
WY108839400Medicaid
UTTPRA07899OtherMOLINA
ID001563800Medicaid
UT8597445OtherWORKERS COMP
UTQM0000075886OtherALTIUS
UT1502954OtherUMWA
NV002087103Medicaid
UT107004823101OtherIHC
UT53258OtherHEALTHY U
UT20114OtherDESERET MUTUAL
UTQM0000075886OtherALTIUS
UT2090168OtherUNITED HEALTHCARE
ID001563800Medicaid