Individual
JESSE P. WACKERBARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
(801) 507-7000
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13312672-1205
UT
207R00000X
Internal Medicine Physician
MD61094335
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
13312672-1205
UT
207RP1001X
Pulmonary Disease Physician
Primary
13312672-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902303613
—
WA
Enumeration date
04/09/2018
Last updated
01/29/2026
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