Individual
KYLE JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
2400 N WASHINGTON BLVD, OGDEN, UT 84414-7233
(801) 786-7500
Mailing address
2900 E 29TH ST STE 100, BRYAN, TX 77802-2623
(979) 436-0485
(979) 436-0063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10323966-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2014
Last updated
03/17/2018
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