Individual
MR. BRIAN JOHN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
391 LEE BLVD STE 300, LEHIGH ACRES, FL 33936-4973
(239) 369-4088
Mailing address
391 LEE BLVD STE 300, LEHIGH ACRES, FL 33936-4973
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9111499
FL
Other
Enumeration date
09/19/2018
Last updated
03/14/2019
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