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Individual
WILLIAM A JACKSON
Active
Individual
WILLIAM A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005302
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02407216
—
NY
Enumeration date
11/04/2005
Last updated
11/23/2011
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