Provider Demographics
NPI:1932308822
Name:EAKIN, JEFFREY LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:EAKIN
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 1:3584 W 9000 S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5710
Mailing Address - Country:US
Mailing Address - Phone:801-601-4423
Mailing Address - Fax:801-601-4422
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5710
Practice Address - Country:US
Practice Address - Phone:801-601-4423
Practice Address - Fax:801-601-4422
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8557523-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1932308822Medicaid
OH0051980Medicaid