Individual
JEFFERY B. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1995 W 9000 S, WEST JORDAN, UT 84088-9345
(801) 566-9888
(801) 566-9899
Mailing address
1995 W 9000 S, WEST JORDAN, UT 84088-9345
(801) 566-9888
(801) 566-9899
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
185550-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107005205101
SELECT MED
UT
01
—
12-00098
UHC
UT
01
—
87-0560776
PEHP
UT
01
—
QM0000012571
ALTIUS
UT
Enumeration date
04/03/2006
Last updated
07/09/2007
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