Individual
BRIAN R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1590
(410) 328-5509
Mailing address
500 E CHIPETA WAY, SALT LAKE CITY, UT 84108-1221
(801) 583-2787
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
5247478-1205
UT
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
D0104213
MD
Other
Enumeration date
10/13/2006
Last updated
08/26/2025
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