Provider Demographics
NPI:1023612868
Name:MIDGLEY, JEFFREY E (LAB)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:MIDGLEY
Suffix:
Gender:M
Credentials:LAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 S KAY DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-8517
Mailing Address - Country:US
Mailing Address - Phone:801-654-2042
Mailing Address - Fax:
Practice Address - Street 1:1673 S KAY DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-8517
Practice Address - Country:US
Practice Address - Phone:801-654-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT46D2188471247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician