Individual
DAVID STEVENS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16 DANFORTH ST, HOOSICK FALLS, NY 12090-1226
(518) 686-5002
(518) 686-1848
Mailing address
PO BOX 304, GLENS FALLS, NY 12801-0304
(518) 926-6992
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
120359
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00359504
—
NY
01
—
P00010321
RR MEDICARE
NY
Enumeration date
10/17/2005
Last updated
06/03/2008
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