Individual
DR. JULIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0100
(801) 581-2507
Mailing address
PO BOX 413037, SALT LAKE CITY, UT 84141-3037
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
125054145
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
8854328-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467615534
—
UT
Enumeration date
07/08/2008
Last updated
09/08/2014
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