NPIMap

Organization Active NPI

David B Jack MD PC

  • Family Medicine Physician
  • Draper, UT
National Provider Identifier
1760528137
Registry record updated Jul 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DAVID B JACK MD PC
Practice address
11760 S 700 E Ste 111
Draper, UT 84020-6605
Phone
(801) 576-8855
Fax
(801) 576-9800
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2009

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

Authorized official

Name
David B Jack, MD
Title
President
Phone
(801) 576-8855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11760 S 700 E Ste 111
Draper, UT 84020-6605

Mailing address

11760 S 700 E Ste 111
Draper, UT 84020-6605
Phone (801) 576-8855

Other names 1

  • Lone Peak Family Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246838400000",
    "number": "1760528137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11760 S 700 E STE 111",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206605",
            "telephone_number": "801-576-8855",
            "fax_number": "801-576-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 S 700 E STE 111",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206605",
            "telephone_number": "801-576-8855",
            "fax_number": "801-576-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID B JACK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2009-07-06",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-576-8855",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Peak Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; 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.