Individual
DR. MARK R. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1474 E ERDA WAY, TOOELE, UT 84074-9737
(435) 849-0779
Mailing address
1474 E ERDA WAY, TOOELE, UT 84074-9737
(435) 849-0779
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
5929640-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D6378
—
UT
Enumeration date
03/30/2006
Last updated
03/21/2016
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