Individual
DR. EDWARD LESLIE JACKSON
Active
Individual
DR. EDWARD LESLIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
E-4775
AR
207RP1001X
Pulmonary Disease Physician
Primary
E-4775
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160768001
—
AR
05
—
200088310A
—
OK
01
—
5N545
AR BCBS
AR
01
—
P00327943
RR MCR
AR
Enumeration date
11/21/2005
Last updated
03/14/2024
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