Individual
KENNETH JASON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18 OLD ETNA RD, LEBANON, NH 03766-1937
(603) 650-5000
Mailing address
18 OLD ETNA RD, LEBANON, NH 03766-1937
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22456
NH
Other
Enumeration date
03/20/2019
Last updated
08/19/2022
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