Organization
FREDRIC N. JACKSON MD INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRIC N JACKSON MD (OWNER)
(206) 241-1818
Entity
Organization
Contact information
Practice address
16259 SYLVESTER RD SW, SUITE 404, BURIEN, WA 98166-3049
(206) 241-1818
Mailing address
16259 SYLVESTER RD SW STE 404, BURIEN, WA 98166-3059
(206) 241-1818
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110046684
RR MEDICARE
WA
05
—
7144389
—
WA
Enumeration date
07/18/2006
Last updated
05/12/2014
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