Individual
DR. MATTHEW PATRICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 MCLAIN, NEWPORT, AR 72112-3638
(870) 523-9337
(870) 217-0312
Mailing address
PO BOX 1960, JONESBORO, AR 72403
(870) 523-9337
(870) 217-0312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-2332
AR
207Q00000X
Family Medicine Physician
E2332
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138695001
—
AR
01
—
5L338
MEDICARE PROVIDER NUMBER
AR
Enumeration date
02/23/2006
Last updated
01/19/2016
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