Provider Demographics
NPI:1144465402
Name:EDWARDS, JENNIFER HOLT (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HOLT
Last Name:EDWARDS
Suffix:
Gender:F
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:INTERMOUNTAIN MEDICAL CENTER
Mailing Address - Street 2:5121 COTTONWOOD STREET
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-507-4238
Mailing Address - Fax:
Practice Address - Street 1:INTERMOUNTAIN MEDICAL CENTER, CRITICAL CARE MEDICINE
Practice Address - Street 2:5121 COTTONWOOD STREET
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL17891207P00000X
UT9518893-1205207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine