| Doctor Name: | DR. JACK D WAHLEN |
| NPI Number: | 1033143508 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 791639051205 |
| Business Practice Address: | 4403 Harrison Blvd Ste 3630 Ogden, UT - 844033271 |
| Business Phone Number: | 8013877900 |
| Business Fax Number: | 8013877910 |
| Mailing Address: | Po Box 27128, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841270128 |
| Phone Number: | 8013877900 |
| Fax Number: | 8013877910 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 02/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RE0101X |
| License Number: | 791639051205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Endocrinology, Diabetes & Metabolism |
| Taxonomy Definition: | An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |