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Individual
JACKSON M EWART
Active
Individual
JACKSON M EWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
8834
SC
2086S0129X
Vascular Surgery Physician
Primary
8834
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088345
—
SC
01
—
7399
MEDICARE GROUP PTAN
SC
Enumeration date
11/14/2007
Last updated
08/05/2020
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