Individual
DR. EDWARD WILLIAM JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
786 S LEFT HAND FORK HOBBLE CREEK CYN, SPRINGVILLE, UT 84663-5916
(801) 489-9381
Mailing address
786 S LEFT HAND FORK HOBBLE CREEK CYN, SPRINGVILLE, UT 84663-5916
(801) 489-9381
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
183721-1205
UT
207QA0505X
Adult Medicine Physician
Primary
183721-1205
UT
Other
Enumeration date
01/02/2023
Last updated
01/02/2023
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