Individual
DR. DOUGLAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
934 CENTER ST, ELGIN, IL 60120-2125
(847) 429-8750
(847) 429-8978
Mailing address
150 QUAIL RIDGE DR, WESTMONT, IL 60559-6142
(630) 321-8300
(630) 321-8750
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036057410
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03607410
—
IL
01
—
04532206
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/14/2005
Last updated
07/08/2007
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