Fagan, Jake

Fagan, Jake is an individual health care provider with primary practice located at 1055 N 500 W # 111 , Provo UT 84604-3305. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Surgical Oncology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Fagan, Jake can be contacted via phone (801) 374-8999.

Contact Information

Primary practice address
1055 N 500 W # 111 Provo UT 84604-3305
Phone: (801) 374-8999
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X MED-PHYS-LIC-76211 Montana
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X MED-PHYS-LIC-76211 Montana
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 76211 Montana
Allopathic & Osteopathic Physicians / Surgical Oncology 2086X0206X MED-PHYS-LIC-76211 Montana
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 6845592-1205 Utah

Profile Details

NPI number 1548688989
LBN Legal business name Fagan, Jake
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 2nd, 2014
Last updated Apr 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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