Organization
DENNIS M JACKSON MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS M JACKSON MD (PRESIDENT)
(505) 490-9738
Entity
Organization
Contact information
Practice address
460 SAINT MICHAELS DR, #1005, SANTA FE, NM 87505-7619
(505) 490-9738
Mailing address
5112 HOLLYWOOD BLVD, #111 PMB 106, LOS ANGELES, CA 90027-6126
(505) 490-9738
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
70142
NM
Other
Enumeration date
04/20/2009
Last updated
04/20/2009
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