Individual
DR. MICHELLE JACKSON
Active
Individual
DR. MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
A102012
CA
207NS0135X
Procedural Dermatology Physician
Primary
A102012
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GG162Z
PTAN
CA
Enumeration date
05/03/2007
Last updated
08/29/2012
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