Jackson, Mark R.

Jackson, Mark R. is an individual health care provider with primary practice located at 1474 E Erda Way , Tooele UT 84074-9737. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as his primary health care specialty. Jackson, Mark R. can be contacted via phone (435) 849-0779.

Contact Information

Primary practice address
1474 E Erda Way Tooele UT 84074-9737
Phone: (435) 849-0779
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 5929640-1205 Utah

Profile Details

NPI number 1003877077
LBN Legal business name Jackson, Mark R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Mar 21st, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003877077 NPPES
Utah MEDICAID D6378

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