Dr. Mark R. Jackson
Emergency Medical Services
1474 E Erda Way
Tooele
, Utah 84074-9737
Dr. Mark R. Jackson
Emergency Medical Services
1474 E Erda Way
Tooele
, Utah 84074-9737
(435) 849-0779
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About
Features
Specialties
- Emergency Medical Services
Languages spoken
- English
Location
First Address
- Dr. Mark R. Jackson
- 1474 E Erda Way
- Tooele, UT
- Zip : 84074-9737
- Phone : (435) 849-0779
Second Address
- Dr. Mark R. Jackson
- 1474 E Erda Way
- Tooele, UT
- Zip : 84074-9737
- Phone : (435) 849-0779
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207PE0004X | Emergency Medical Services | 5929640-1205 | UT |
National Provider Identifier
| NPI | 1003877077 |
|---|---|
| Provider Name | Dr. Mark R. Jackson |
| First Address | Tooele, UT 84074-9737 |
| Second Address | Tooele, UT 84074-9737 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/03/2006 |
| Last Update Date | 21/03/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| D6378 | (05) | UT |
| G78689 | (02) | UT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.