Individual
MR. JOHN THOMAS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
22007 MARINE VIEW DR S, SUITE 104, DES MOINES, WA 98198-6259
(206) 592-1423
(206) 592-1428
Mailing address
PO BOX 98530, DES MOINES, WA 98198-0530
(206) 592-1423
(206) 592-1428
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00005314
WA
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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