Individual
JACKSON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
496 E 100 N, PRICE, UT 84501-2667
(435) 637-4320
Mailing address
PO BOX 867, PRICE, UT 84501-0867
(435) 637-7200
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
UT
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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