Individual
DR. JON C JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4770 S RIDGEWOOD AVE, PORT ORANGE, FL 32127-4544
(386) 761-0050
(386) 761-1167
Mailing address
4770 S RIDGEWOOD AVE, PORT ORANGE, FL 32127-4544
(386) 761-0050
(386) 761-1167
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME28054
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013
CIGNA
FL
01
—
64353
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/05/2006
Last updated
07/09/2007
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