| Robert T Jackson, MD | |
|
1055 N 500 W, Suite 121, Provo, UT 84604-3305 | |
| (801) 373-7350 | |
| (801) 812-5401 |
| Full Name | Robert T Jackson |
|---|---|
| Gender | Male |
| Speciality | Orthopaedic Surgery |
| Location | 1055 N 500 W, Provo, Utah |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407959695 | NPI | - | NPPES |
| 107006624103 | Other | UT | IHC |
| 200045123 | Other | UT | PALMETTO |
| 68074 | Other | UT | PEHP |
| 09-00414 | Other | UT | UNITED HEALTHCARE |
| 35879 | Other | UT | DMBA |
| 870281028RTJ | Other | UT | EMIA |
| 870281028000 | Medicaid | UT | |
| QM0000056631 | Other | UT | ALTIUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | 158297-1205 (Utah) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Robert T Jackson, MD 1055 N 500 W, Credentialing Department, Provo, UT 84604-3305 Ph: (801) 354-8225 | Robert T Jackson, MD 1055 N 500 W, Suite 121, Provo, UT 84604-3305 Ph: (801) 373-7350 |
Travis A Peterson, DO Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 1055 N 500 W Ste 207, Provo, UT 84604 Phone: 801-375-4263 Fax: 801-429-8085 | |
Michael Callahan, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 1055 N 500 W, Provo, UT 84604 Phone: 801-763-3885 Fax: 801-763-3887 | |
Jeffrey M Wallentine, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1055 N 500 W, Suite 121, Provo, UT 84604 Phone: 801-373-7350 Fax: 801-812-5401 | |
Dr. Trevor Shelton, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1157 N 300 W, Provo, UT 84604 Phone: 801-357-1200 | |
Toby Johnson, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1055 N 500 W Ste 207, Provo, UT 84604 Phone: 801-373-7350 Fax: 801-429-8085 | |
Richard T Jackson, MD Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 1055 N 500 W, Suite 121, Provo, UT 84604 Phone: 801-373-7350 Fax: 801-812-5401 | |
Joshua Nelson Speirs, MD Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 1157 N 300 W Ste 302, Provo, UT 84604 Phone: 801-357-4470 Fax: 801-357-4473 |