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Individual

JORDAN R TUCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 213-9500
Mailing address
404 E 3200 N, LEHI, UT 84043-9637
(801) 949-8339

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
177120115
DRIVERS LISENCE
UT
Enumeration date
01/17/2023
Last updated
04/16/2025
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