Provider Demographics
NPI:1720196785
Name:VEIGEL, JAKE DOYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:DOYLE
Last Name:VEIGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2310
Mailing Address - Country:US
Mailing Address - Phone:385-282-2700
Mailing Address - Fax:385-282-2701
Practice Address - Street 1:389 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2310
Practice Address - Country:US
Practice Address - Phone:385-282-2700
Practice Address - Fax:385-282-2701
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344837-1205207Q00000X, 207QS0010X
NY253843207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000059805Medicare PIN
000059808Medicare PIN
UT000063584Medicare PIN
000059809Medicare PIN
000059807Medicare PIN
000059806Medicare PIN
000059803Medicare PIN
000059804Medicare PIN