Provider Demographics
NPI:1871591958
Name:ASHDOWN, JAN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:MICHAEL
Last Name:ASHDOWN
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 1:950 S 500 W
Mailing Address - Street 2:#104
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4724
Mailing Address - Country:US
Mailing Address - Phone:435-723-1114
Mailing Address - Fax:435-723-1173
Practice Address - Street 1:950 S 500 W
Practice Address - Street 2:#104
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4724
Practice Address - Country:US
Practice Address - Phone:435-723-1114
Practice Address - Fax:435-723-1173
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186908-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10970Medicaid
E93327Medicare UPIN
ID1128903Medicare PIN