Individual
DR. MARK K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 W 6TH ST, OSWEGO, NY 13126-2507
(315) 349-5000
Mailing address
104 W UTICA ST, OSWEGO, NY 13126-3031
(315) 343-0257
(315) 343-0948
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
196101
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01880015
—
NY
Enumeration date
08/30/2005
Last updated
09/13/2007
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