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Individual
ROBERT T JACKSON
Active
Individual
ROBERT 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
158297-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-00414
UNITED HEALTHCARE
UT
01
—
107006624103
IHC
UT
01
—
200045123
PALMETTO
UT
01
—
35879
DMBA
UT
01
—
68074
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028RTJ
EMIA
UT
01
—
QM0000056631
ALTIUS
UT
Enumeration date
09/06/2006
Last updated
11/02/2018
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