Anderson, Jacob Douglas
Anderson, Jacob Douglas is an sole proprietor health care provider with primary practice located at 630 E 1400 N Ste 150 , Logan UT 84341-2549. He recently has 4 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Occupational Medicine, Physician Assistants & Advanced Practice Nursing Providers / Family, Ambulatory Health Care Facilities / Primary Care, Ambulatory Health Care Facilities / Urgent Care. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Anderson, Jacob Douglas can be contacted via phone (435) 915-4465.Contact Information
Primary practice address
630 E 1400 N Ste 150
Logan UT 84341-2549
Phone: (435) 915-4465
Fax: (435) 787-8509
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Occupational Medicine | 261QX0100X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 7942683-4405 | Utah |
| Ambulatory Health Care Facilities / Primary Care | 261QP2300X | ||
| Ambulatory Health Care Facilities / Urgent Care | 261QU0200X |
Profile Details
| NPI number | 1316329220 |
|---|---|
| LBN Legal business name | Anderson, Jacob Douglas |
| Credentials | DNP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 26th, 2015 |
| Last updated | Jul 8th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316329220 | NPPES |
| Idaho | Other | 1205300407 | NPI |
| Idaho | Other | 833011825 | NPI |
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