Individual
MARK A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 PAVILIONS CIRCLE, MARK A JACKSON MD PLC, TRAVERSE CITY, MI 49684
(231) 935-0913
(231) 935-0984
Mailing address
10850 E TRAVERSE HWY, STE 4400, TRAVERSE CITY, MI 49684-1364
(231) 346-6930
(231) 346-6017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
051555
MI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
4301051555
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080B86010
BLUE SHIELD
MA
05
—
1820487
—
MI
Enumeration date
02/02/2006
Last updated
10/23/2015
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