Individual
JACKSON WALTER DEERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2245 N 400 E STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 753-5845
Mailing address
2245 N 400 E STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 753-5845
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
13768482-1205
UT
Other
Enumeration date
05/15/2019
Last updated
08/09/2024
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