Individual
ROBERT E. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 S EAGLE RD, SUITE 3112, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301087650
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301087650
MI
Other
Enumeration date
03/22/2007
Last updated
12/13/2013
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