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Individual
RICHARD T JACKSON
Active
Individual
RICHARD T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
158498-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-00376
UTAH HEALTHCARE
UT
01
—
107004917104
IHC
UT
01
—
20045125
PALMETTO
UT
01
—
36165
DMBA
UT
01
—
68073
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028RCH
EMIA
UT
01
—
QM000056630
ALTIUS
UT
Enumeration date
09/06/2006
Last updated
11/27/2023
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