Provider Demographics
NPI:1871539411
Name:MACINTYRE, JAMES G (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MACINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-0150
Mailing Address - Country:US
Mailing Address - Phone:801-568-3480
Mailing Address - Fax:801-568-3482
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:# 405
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5710
Practice Address - Country:US
Practice Address - Phone:801-568-3480
Practice Address - Fax:801-568-3482
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186073-1205207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005810104Medicare PIN
UTF14330Medicare UPIN