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Individual
DR. WOODY H JACKSON
Active
Individual
DR. WOODY H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD063122L
PA
207R00000X
Internal Medicine Physician
MD063122L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001688698
—
PA
01
—
232359401
MAIN LINE HEALTHCARE
PA
05
—
5919880
—
NC
05
—
Q0029K
—
SC
Enumeration date
02/13/2006
Last updated
08/19/2014
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