David B Jack, MD

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

License

168941-1205 Issued in UT

Practice address

74 E Kimballs LN Ste 260
Draper, UT 84020-5009

Phone

(801) 545-8480

Fax

(801) 253-1602

NPI assigned

Sep 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: david.jack@hca3.eclinicaldirectplus.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1255434296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198560",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303841721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 E KIMBALLS LN STE 260",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205009",
            "telephone_number": "801-545-8480",
            "fax_number": "801-253-1602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "DAVID",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-02-01",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "UT",
            "license": "168941-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DAVID.JACK@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "74 E Kimballs Ln Ste 260",
            "city": "Draper",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840205009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristin Isaacson
• Wendy Islas-Aguilar
• Emily Israelsen, SLP
• Ivora Inc
• Rowan Siegfried Jachmann
• Phoebe Jacklin
• Katie Jackman
• Makala Jackson-Clinton
• Amelia Jackson, M.S., SLP-CCC
• Devin S Jackson, PHARMD

• Obesity Medicine (Family Medicine) Physician in Draper, UT
• Providers in Draper, UT by specialty
• Obesity Medicine (Family Medicine) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.