Individual
MR. ORLAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1312 HIGHWAY 49 N, BEULAH, ND 58523-6038
(701) 873-4445
(701) 873-4199
Mailing address
1312 HIGHWAY 49 N, BEULAH, ND 58523-6038
(701) 873-4445
(701) 873-4199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ND5650
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13470
—
ND
01
—
27705
BLUE CROSS BLUE SHIELD ND
ND
Enumeration date
01/05/2006
Last updated
03/04/2021
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