Organization
LARRY A. JACKSON, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY ARTHUR JACKSON MD (PRESIDENT)
(541) 726-0550
Entity
Organization
Contact information
Practice address
1717 CENTENNIAL BLVD, SUITE 7, SPRINGFIELD, OR 97477-3378
(541) 726-0550
(541) 726-7485
Mailing address
1717 CENTENNIAL BLVD, SUITE 7, SPRINGFIELD, OR 97477-3378
(541) 726-0550
(541) 726-7485
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
08513
OR
Other
Enumeration date
05/21/2013
Last updated
05/21/2013
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