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NPI Code Detail

MEDICARE: HALEY W JACKSON MD

MEDICARE: HALEY W JACKSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician11336450-1205UT
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1396248159
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY W JACKSON MD
Provider Business Mailing Address
First Line : 273 N 1325 W
Second Line :
City : SPRINGVILLE
State : UT
Zip : 84663-3283
Country : US
Telephone Number : 385-450-4572
Fax Number :
Provider Business Practice Location Address
First Line : 1900 N STATE ST
Second Line :
City : PROVO
State : UT
Zip : 84604-1341
Country : US
Telephone Number : 801-373-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 07/15/2021

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Directions to “ HALEY W JACKSON MD” Practice Location

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