Individual
BENJAMIN CLARK JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, STE 112, PROVO, UT 84604-3305
(801) 812-4624
(801) 812-4699
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
9693882-1205
UT
Other
Enumeration date
04/02/2009
Last updated
03/25/2025
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