DR. RICHARD TAYLOR JACKSON II (NPI# 1922248202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922248202 |
| Entity Type | Individual |
| Full Name | DR. RICHARD TAYLOR JACKSON II |
| Credential | MD |
| Practice Address |
1055 N 500 W Suite 112 Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8018124624 |
| Practice Fax Number | 8018124699 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2020-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
7960088-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
R1094 | KY | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629520770 | Richard Allen Jackson | Social Worker | 201 W Laurel St, Brainerd, MN 56401-3902 | 2016-10-25 |
| 1386924363 | Richard Ray Jackson | Social Worker | 104 S Ridge Ave, Troy, OH 45373-2704 | 2011-08-23 |
| 1124240197 | Richard Jackson | Psychologist | 2650 West 2700 South, Syracuse, UT 84075 | 2007-05-02 |
| 1508081993 | Richard Jackson | Psychiatry & Neurology | E 4111 Andover Road Suite 220, Bloomfield Hills, MI 48302 | 2007-04-13 |
| 1851478101 | Richard Jackson | Pharmacist | 420 Delaware St Se # Mmc812, Minneapolis, MN 55455-0341 | 2006-11-01 |
| 1972616134 | Richard Pharus Jackson | Optometrist | 216 W Washington St, Anthony, TX 79821-9304 | 2006-08-15 |
| 1801810163 | Richard Edwin Jackson | Dentist | 109 Timbermill Dr, Lexington, SC 29073-7138 | 2006-07-27 |
| 1366483406 | Richard D Jackson | Family Medicine | 29 Eastbrook Rd, Ronks, PA 17572-9769 | 2006-06-09 |
| 1659328060 | Richard Jackson | Emergency Medicine | 505 Regency Xing, Southlake, TX 76092-9501 | 2006-05-30 |
| 1174587505 | Richard E Jackson | Physician Assistant | 21260 Olean Blvd Ste 200, Port Charlotte, FL 33952-6742 | 2006-04-13 |
| Street Address |
1055 N 500 W SUITE 112 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144223835 | Bruce C Mcallister | Specialist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2005-05-27 |
| 1922641448 | Lilian Silva Dana | Nurse Practitioner | 1055 N 500 W, Suite. 222, Bldg. C, Provo, UT 84604 | 2019-10-28 |
| 1407373574 | Kristie Christensen | Nurse Practitioner | 1055 N 500 W, Ste 101, Bldg C, Provo, UT 84604-3305 | 2017-08-29 |
| 1942664867 | Holly Ann Bishop Michaels | Dietitian, Registered | 1055 N 500 W, Attn. Credentialing, Provo, UT 84604-3305 | 2016-04-06 |
| 1841650967 | Maile Yuzon | Physician Assistant | 1055 N 500 W, Ste 212, Provo, UT 84604-3305 | 2016-03-02 |
| 1497127658 | Kayla Hamrick Lussier | Nurse Practitioner | 1055 N 500 W, Suite 212, Provo, UT 84604-3305 | 2015-10-28 |
| 1962873281 | Ryan Francis | Nurse Practitioner | 1055 N 500 W, Ste 121, Provo, UT 84604-3305 | 2015-10-13 |
| 1083082283 | Leslee Ronald Adams | Registered Nurse | 1055 N 500 W, Ste 211, Provo, UT 84604-3305 | 2015-09-04 |
| 1750763629 | Cydne Suzannah Baird Evans | Physician Assistant | 1055 N 500 W, Ste 100, Provo, UT 84604-3305 | 2015-06-26 |
| 1073903720 | Rosanne Johnson Oliver | Nurse Practitioner | 1055 N 500 W, Ste 205, Provo, UT 84604-3305 | 2015-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487090528 | Wendell Andrew Gibby | Radiology | 3152 N University Ave Dept Of, Provo, UT 84604-4745 | 2013-05-16 |
| 1457688590 | James Edwin Rasband | Radiology | 3757 Pebble Ln, Provo, UT 84604-5267 | 2009-11-11 |
| 1003291568 | Ihc Health Services Inc | Radiology | 1034 N 500 W, Provo, UT 84604-3380 | 2015-07-27 |
| 1750704532 | Notus Imaging and Research Laboratories | Radiology | 280 River Park Dr, Suite 100, Provo, UT 84604-5764 | 2014-01-29 |
| 1750624979 | Conrad Curtis Gibby | Radiology | 3152 N University Ave, Provo, UT 84604-4745 | 2013-04-06 |
| 1982846119 | Benjamin Clark Jacobs | Radiology | 1055 N 500 W, Ste 112, Provo, UT 84604-3305 | 2009-04-02 |
| 1033371760 | Daniel Lyman Corey | Radiology | 1034 N 500 W, Provo, UT 84604-3380 | 2008-06-25 |
| 1316106131 | Fred Jeston Dawson | Radiology | 1055 N 500 W, Suite 112, Provo, UT 84604-3305 | 2008-06-06 |
| 1316113228 | Kimball Lael Christianson | Radiology | 1055 N 500 W, Suite 112, Bldg. C, Provo, UT 84604 | 2008-05-01 |
| 1629266317 | Thomas Briggs Sanders | Radiology | 1034 N 500 W, Provo, UT 84604-3380 | 2007-10-09 |
| Find all providers in PROVO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.