Individual
DR. RICHARD LEON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-3501
(801) 581-3899
Mailing address
295 CHIPETA WAY, PEDS ADMIN, SALT LAKE CITY, UT 84108-1220
(801) 581-2321
(801) 581-3899
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
158572-1205
UT
Other
Enumeration date
05/24/2006
Last updated
09/11/2012
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