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Individual
ROOSEVELT T JACKSON JR.
Active
Individual
ROOSEVELT T JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME45529
FL
207Q00000X
Family Medicine Physician
Primary
ME45529
FL
207QA0401X
Addiction Medicine (Family Medicine) Physician
ME45529
FL
207W00000X
Ophthalmology Physician
ME45529
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043150800
—
FL
Enumeration date
04/17/2007
Last updated
12/17/2018
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