Provider Demographics
NPI:1538216742
Name:CAMP, JACOB LAWRENCE (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LAWRENCE
Last Name:CAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N 400 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1913
Mailing Address - Country:US
Mailing Address - Phone:801-224-4080
Mailing Address - Fax:
Practice Address - Street 1:331 N 400 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1913
Practice Address - Country:US
Practice Address - Phone:801-224-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9761391207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services