Provider Demographics
NPI:1881128353
Name:JEMISON, ERIC JACOB (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JACOB
Last Name:JEMISON
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:866-415-6556
Mailing Address - Fax:
Practice Address - Street 1:5541 W 13400 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-5640
Practice Address - Country:US
Practice Address - Phone:801-871-4700
Practice Address - Fax:801-871-4799
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10939795-1204207Q00000X
WAOP61065129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine