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Individual

ROBERT A JELACO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4650 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3000
(801) 475-3001
Mailing address
4650 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3000
(801) 475-3001

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102917-1206
UT

Other

Enumeration date
10/14/2005
Last updated
02/06/2013
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