Active NPI
Jacob M. Donnelly, DO
- Forensic Pathology Physician
- Taylorsville, UT
National Provider Identifier
1821652124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Pathology Physician
- License
- 13312635-1204
- Practice address
- 4451 S 2700 W
Taylorsville, UT 84129-8601 - Phone
- (801) 581-2121
- NPI assigned
- Apr 23, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Pathology Physician | 207ZF0201X | 13312635-1204 | UT | Primary |
Addresses
Primary practice location
4451 S 2700 W
Taylorsville, UT 84129-8601
Mailing address
4451 S 2700 W
Taylorsville, UT 84129-8601
Phone (801) 581-2121
Other practice location 1
2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-3331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13312635-1204 | UT | MD | Forensic Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679356800000",
"number": "1821652124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4451 S 2700 W",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841298601",
"telephone_number": "801-581-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4451 S 2700 W",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841298601",
"telephone_number": "801-581-2121"
}
],
"practiceLocations": [
{
"address_1": "2315 Stockton Blvd",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958172201",
"country_code": "US",
"telephone_number": "916-734-3331",
"fax_number": "916-734-6468",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DONNELLY",
"first_name": "JACOB",
"middle_name": "M.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-23",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207ZF0201X",
"taxonomy_group": "",
"desc": "Pathology, Forensic Pathology",
"state": "UT",
"license": "13312635-1204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylorsville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.