Individual
DR. MICHAEL REID JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5350 ORCHARD ST W, SUITE 202, UNIVERSITY PLACE, WA 98467-4817
(253) 472-4444
(253) 301-4360
Mailing address
5350 ORCHARD ST W, SUITE 202, UNIVERSITY PLACE, WA 98467-4817
(253) 472-4444
(253) 401-4360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0019523
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1077510
—
WA
Enumeration date
07/18/2006
Last updated
03/18/2014
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