# DAVID B JACK MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lone Peak Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760528137
- **Authorized official:** DAVID B JACK MD (PRESIDENT)
- **Authorized official phone:** (801) 576-8855

## Contact information

- **Practice address:** 11760 S 700 E STE 111, DRAPER, UT 84020-6605
- **Practice address phone:** (801) 576-8855
- **Practice address fax:** (801) 576-9800
- **Mailing address:** 11760 S 700 E STE 111, DRAPER, UT 84020-6605
- **Mailing address phone:** (801) 576-8855
- **Mailing address fax:** (801) 576-9800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 07/06/2009