Provider Demographics
NPI:1447781356
Name:JEPSEN, ALEX SPENCER (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:SPENCER
Last Name:JEPSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 N MARIO CAPECCHI DR 3RD FLOOR NORTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-7822
Mailing Address - Fax:801-585-9166
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0816
Practice Address - Country:US
Practice Address - Phone:801-581-7822
Practice Address - Fax:801-585-9166
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7400747-1205207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine