Jacob Church, PA

NPI #1598495855 in Provo, Utah

Provider Information

NPI Number: 1598495855
Entity Type: Individual
Name: Jacob Church, PA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Jun 10, 2022
Last Updated: Jun 10, 2022

Practice Location

Address: 1055 N 500 W STE 121
City: Provo
State: Utah
ZIP Code: 84604-3305
Phone: (013) 737-3508

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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