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Individual
MR. MELVIN L JACKSON
Active
Individual
MR. MELVIN L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G32876
CA
207R00000X
Internal Medicine Physician
G32876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G328760
BLUE SHIELD
—
05
—
00G328760
—
CA
01
—
G32876
BLUE CROSS
CA
Enumeration date
06/09/2006
Last updated
02/27/2009
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