Individual
DR. JACK D WAHLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4403 HARRISON BLVD, STE 3630, OGDEN, UT 84403-3271
(801) 387-7900
(801) 387-7910
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-7900
(801) 387-7910
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
791639051205
UT
Other
Enumeration date
07/10/2006
Last updated
02/26/2008
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