Individual
MR. TIMOTHY LAWRENCE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
300 S 6TH ST, WILLIAMS, AZ 86046-0110
(928) 635-4441
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5407
AZ
Other
Enumeration date
10/19/2010
Last updated
07/21/2021
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