Individual
FRANK WILSON JACKSON III
Active
Individual
FRANK WILSON JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD055416L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016834680003
—
PA
01
—
01024101
CAPITAL BLUE CROSS
PA
01
—
100012586
RAILROAD MEDICARE
PA
01
—
527552
HIGHMARK BLUE SHIELD
PA
01
—
5333615
AETNA US HEALTHCARE
PA
01
—
G84061
HEALTHAMERICA
PA
Enumeration date
07/18/2005
Last updated
09/15/2020
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