Individual
DENNIS N. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(801) 581-2121
Mailing address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036172023
IL
207P00000X
Emergency Medicine Physician
13323091-1205
UT
207P00000X
Emergency Medicine Physician
Primary
27025
NV
207PS0010X
Sports Medicine (Emergency Medicine) Physician
13323091-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J250139622810
STATE OF MICHIGAN
—
Enumeration date
06/28/2020
Last updated
07/02/2025
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