Organization
ID CONSULTS AND SERVICES, PA
Active
Parent organization
ID CONSULTS AND SERVICES, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
ID CONSULTS AND SERVICES, PA
Authorized official
DR. JERRY JACKSON MD (PRESIDENT)
(305) 615-3300
Entity
Organization
Contact information
Practice address
3142 NORTHSIDE DR STE 101, KEY WEST, FL 33040-8012
(305) 615-3300
Mailing address
513 OLIVIA ST, KEY WEST, FL 33040-7438
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME114239
FL
207RI0200X
Infectious Disease Physician
Primary
ME114239
FL
Other
Enumeration date
03/10/2014
Last updated
03/10/2014
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