Individual
JACOB GRANT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1533 W CANNONWOOD PL, TAYLORSVILLE, UT 84123-6693
(208) 350-1970
Mailing address
1533 W CANNONWOOD PL, TAYLORSVILLE, UT 84123-6693
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
14297271-1206
UT
Other
Enumeration date
08/04/2026
Last updated
08/04/2026
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