Individual
DR. JOHN JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 NW 183RD ST STE 306, MIAMI, FL 33169
(305) 705-6688
Mailing address
111 NW 183RD ST STE 306, MIAMI, FL 33169-4599
(305) 705-6688
(305) 946-1516
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
37656
FL
208D00000X
General Practice Physician
Primary
ME37656
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025035200
—
FL
Enumeration date
11/21/2005
Last updated
03/27/2020
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