Jake Fagan, MD
Jake Fagan, MD is a Micrographic Dermatologic Surgery (Mds) in Provo, Utah. Graduated from West Virginia University School of Medicine in 2014, 12 years ago. Practices with Revere Health PC, a 410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Montana and Utah.
- Years since qualifying
- 12
- Trained at
- West Virginia University School of Medicine
- Licensed in
- MT, UT
- In the registry since
- 2014
- Specialties on file
- 6
What do these letters mean?
- MD — Doctor of Medicine
- A physician who completed allopathic medical school.
Practice location Address checks out
1055 N 500 W # 111Provo, UT 84604-3305
Phone: (801) 374-8999
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Additional practice locations (1)
- 801 N 29th St, Billings, MT 59101-0905 — (406) 238-2500
Specialties & licences
| MOHS-Micrographic Surgery Physician (primary) | Taxonomy 207ND0101X · Licence 6845592-1205 (UT) |
|---|---|
| Dermatology Physician | Taxonomy 207N00000X · Licence MED-PHYS-LIC-76211 (MT) |
| MOHS-Micrographic Surgery Physician | Taxonomy 207ND0101X · Licence MED-PHYS-LIC-76211 (MT) |
| MOHS-Micrographic Surgery Physician | Taxonomy 207ND0101X · Licence 76211 (MT) |
| Surgical Oncology Physician | Taxonomy 2086X0206X · Licence MED-PHYS-LIC-76211 (MT) |
| Student in an Organized Health Care Education/Training Program | Taxonomy 390200000X |
Record details
| NPI number | 1548688989 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | MD |
| Sole proprietor | No |
| NPI enumerated | April 2, 2014 |
| Last updated in NPPES | April 17, 2024 |
| Certification date | April 3, 2024 |
| Mailing address | 1055 N 500 W, Att Credentialing, Provo, UT 84604 |
Medicare enrollment
| Medicare specialty | MICROGRAPHIC DERMATOLOGIC SURGERY (MDS) |
|---|---|
| Also practises | DERMATOLOGY |
| Medical school | WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE |
| Graduated | 2014 (12 years in practice) |
| Group practice | Revere Health Pc — 410 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
Other providers in Provo
-
Brian R Bradshaw, MD
1055 N 500 W Ste 111, Provo, UT 84604-3305 · (801) 374-8999
-
Clearskin Utah PLLC
2332 S Alaska Ave, Provo, UT 84606-6624 · (801) 367-3737
-
Mark L Donaldson, MD
2976 Cherokee Ln Ste 111, Provo, UT 84604-4356 · (801) 687-7575
-
Daniel Glade, MD
5314 N 250 W Ste 220, Provo, UT 84604-7746 · (801) 225-8484
-
Margaret Hammond
395 W Cougar Blvd Ste 604, Provo, UT 84604-3331 · (801) 357-0613
-
Ihc Health Services Inc
395 W Cougar Blvd Ste 604, Provo, UT 84604-3331 · (801) 371-6464
-
Garrett C Lowe, MD
3200 N Canyon Rd Ste D, Provo, UT 84604-4678 · (801) 373-3300