Healthcare Provider Details

I. General information

NPI: 1700467537
Provider Name (Legal Business Name): JACOB T DARNELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

IV. Provider business mailing address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

V. Phone/Fax

Practice location:
  • Phone: 13-640-0588
  • Fax:
Mailing address:
  • Phone: 801-364-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number14224208-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14224208-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: