Individual
MATTHEW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Contact information
Practice address
2240 ADAMS AVE, OGDEN, UT 84401-1511
(801) 393-5355
(801) 394-4609
Mailing address
2240 ADAMS AVE, OGDEN, UT 84401-1511
(801) 393-5355
(801) 394-4609
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
126260058906
UT
Other
Enumeration date
07/30/2019
Last updated
11/08/2022
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