Individual
TAYLOR S. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15 N MEDICAL DR STE 1100, SALT LAKE CITY, UT 84112-1100
(801) 583-2787
Mailing address
15 N MEDICAL DR STE 1100, SALT LAKE CITY, UT 84112-1100
(801) 583-2787
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
12985852-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/29/2021
Last updated
08/16/2022
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