Individual
JACOB IVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 W LAYTON PKWY STE 1A, LAYTON, UT 84041-3692
(801) 543-6875
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14234161-1205
UT
Other
Enumeration date
03/22/2024
Last updated
11/18/2025
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