Individual
ROBERT ELVON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
875 S VANGUARD WAY, SUITE 200 D, MERIDIAN, ID 83642
(208) 782-6730
(208) 759-7822
Mailing address
875 S VANGUARD WAY, SUITE 200 D, MERIDIAN, ID 83642
(208) 782-6730
(208) 759-7822
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
4301087650
MI
208800000X
Urology Physician
Primary
M-11868
ID
390200000X
Student in an Organized Health Care Education/Training Program
4301087650
MI
Other
Enumeration date
03/22/2007
Last updated
06/02/2026
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