Individual
MR. JAKE O MCCLOSKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
170 E ALTAMIRA DR, CEDAR CITY, UT 84720-3509
(435) 586-0213
Mailing address
920 S 25 E, CEDAR CITY, UT 84720-4176
(435) 704-1661
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
UT
Enumeration date
08/06/2009
Last updated
08/06/2009
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