Jackson, Robert T

Jackson, Robert T is an individual health care provider with primary practice located at 1055 N 500 W Suite 121, Provo UT 84604-3305. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Jackson, Robert T can be contacted via phone (801) 373-7350.

Contact Information

Primary practice address
1055 N 500 W Suite 121 Provo UT 84604-3305
Phone: (801) 373-7350
Fax: (801) 812-5401
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 158297-1205 Utah

Profile Details

NPI number 1407959695
LBN Legal business name Jackson, Robert T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2006
Last updated Nov 2nd, 2018 - about 6 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 1407959695 NPPES
Utah Other 107006624103 IHC
Utah Other 200045123 IHC
Utah Other 68074 IHC
Utah Other 09-00414 IHC
Utah Other 35879 IHC
Utah Other 870281028RTJ IHC
Utah MEDICAID 870281028000 IHC
Utah Other QM0000056631 IHC

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