Individual
MR. THOMAS MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7 BITTERROOT ROAD, CARMEN, ID 83462
(208) 756-8047
Mailing address
7 BITTERROOT ROAD, PO BOX 47, CARMEN, ID 83462
(208) 756-8047
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
021
ID
Other
Enumeration date
06/18/2008
Last updated
06/18/2008
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