Doctor Name: | DR. MARK R. JACKSON |
NPI Number: | 1003877077 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 5929640-1205 |
Business Practice Address: | 1474 E Erda Way Tooele, UT - 840749737 |
Business Phone Number: | 4358490779 |
Business Fax Number: | |
Mailing Address: | 1474 E Erda Way, TOOELE |
State: | UT |
Postal Code: | 840749737 |
Phone Number: | 4358490779 |
Fax Number: | |
NPI Enumeration Date: | 03/30/2006 |
NPI Last Update Date: | 03/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207PE0004X |
License Number: | 5929640-1205 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Emergency Medicine |
Taxonomy Specialization: | Emergency Medical Services |
Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |