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General NPI Number Information
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NPI Number | 1952363285
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Entity Type | Individual
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Provider Name | JEFFERY B. JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1995 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9345
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Country | US
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Telephone | 801-566-9888
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Fax | 801-566-9899
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Provider Business Mailing Address
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Address Line | 1995 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9345
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Country | US
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Telephone | 801-566-9888
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Fax | 801-566-9899
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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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | 185550-1205
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License Number State | UT
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