Provider Demographics
NPI:1730509613
Name:GARLICK, JARED (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:GARLICK
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 1:11762 S STATE ST STE 345
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7173
Mailing Address - Country:US
Mailing Address - Phone:801-932-8736
Mailing Address - Fax:
Practice Address - Street 1:11762 S STATE ST STE 345
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7173
Practice Address - Country:US
Practice Address - Phone:801-932-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9529258-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery