Provider Demographics
NPI:1821676099
Name:WORLEY, JACOB C (DO)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:WORLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2825 NE KENDALLWOOD PKWY APT 4
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2035
Mailing Address - Country:US
Mailing Address - Phone:435-994-2535
Mailing Address - Fax:
Practice Address - Street 1:560 W 465 N STE 604
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8006
Practice Address - Country:US
Practice Address - Phone:435-994-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT14209819-1204207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology