Individual
KYLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
3400 SPRUCE STREET, 4 SILVERSTEIN, PHILADELPHIA, PA 10104-4206
(215) 615-4949
(215) 662-2244
Mailing address
3400 SPRUCE STREET, 4 SILVERSTEIN, PHILADELPHIA, PA 10104-4206
(215) 615-4949
(215) 662-2244
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD485481
PA
Other
Enumeration date
03/25/2014
Last updated
10/30/2024
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