Brent D Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1638281205 Issued in UT

Practice address

700 S Highway 99
#3
Fillmore, UT 84631-5134

Phone

(435) 743-5555

NPI assigned

Jul 31, 2006

Last updated

Jun 15, 2010By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1962418210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "435-743-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S HIGHWAY 99",
            "address_2": "#3",
            "city": "FILLMORE",
            "state": "UT",
            "postal_code": "846315134",
            "telephone_number": "435-743-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRENT",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "1638281205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ihc Health Services, Inc (Fillmore Community Hospital)
• Ihc Health Services, Inc (Intermountain Homecare Home Health Fillmore)
• Ihc Health Services, Inc. (Fillmore Clinic)
• Ihc Health Services, Inc. (Intermountain Health Fillmore Community Hospital)
• Jackson Eye Care, Inc (Russell B Jackson OD)
• Russell B Jackson, OD
• Jacob D Finlinson, D.D.S, LLC
• Tonia Jorgensen, PTA
• Randleman Pearsall Keltner, DPT
• Shianna Markward

• Family Medicine Physician in Fillmore, UT
• Providers in Fillmore, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; 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.