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Organization

GRANT W JACKSON MD PS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GRANT JACKSON MD (DIRECTOR)
(360) 249-1980
Entity
Organization

Contact information

Practice address
319 E PIONEER AVE, MONTESANO, WA 98563-4601
(360) 249-1980
Mailing address
319 E PIONEER AVE, MONTESANO, WA 98563-4601
(360) 249-1980

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60002207
WA

Other

Enumeration date
08/05/2008
Last updated
08/05/2008
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