Individual
MR. JAY CANNON LAMBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4095 E PONY EXPRESS PKWY, STE 1, EAGLE MOUNTAIN, UT 84005-5529
(801) 429-8037
(801) 753-7476
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
413
MT
363A00000X
Physician Assistant
Primary
9412400-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0071813
CAH MEDICARE PART B
MT
05
—
4307589
—
MT
01
—
P00307087
RAILROAD MEDICARE
MT
Enumeration date
10/03/2006
Last updated
11/12/2018
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