Individual
JACOB RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
325 W LOGAN RD, GARDEN CITY, UT 84028-7754
(208) 232-7862
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14190579-1206
UT
Other
Enumeration date
08/09/2022
Last updated
11/20/2024
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