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General NPI Number Information
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NPI Number | 1093058604
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Entity Type | Individual
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Provider Name | DANIEL LARSEN JACOBS DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 5801 S FASHION BLVD STE 195
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City | MURRAY
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State | UT
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Zip | 84107-8114
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Country | US
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Telephone | 801-829-7246
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Fax | 801-655-9615
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Provider Business Mailing Address
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Address Line | 5801 S FASHION BLVD STE 195
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City | MURRAY
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State | UT
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Zip | 84107-8114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 12931506-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 12931506-1204
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 12931506-1204
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License Number State | UT
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