Healthcare Provider Details

I. General information

NPI: 1720196785
Provider Name (Legal Business Name): JAKE DOYLE VEIGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 W LAKE PARK BLVD
WEST VALLEY CITY UT
84120-8208
US

IV. Provider business mailing address

2000 S 900 E
SALT LAKE CITY UT
84105-3208
US

V. Phone/Fax

Practice location:
  • Phone: 801-902-7960
  • Fax: 801-902-7999
Mailing address:
  • Phone: 801-464-7500
  • Fax: 801-464-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number344837-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number344837
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number344837-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: