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Individual

WESLEY MATTHEW JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5801 MOUNTAIN ISLAND DR, DURHAM, NC 27713-8909
(817) 428-2404
Mailing address
5801 MOUNTAIN ISLAND DR, DURHAM, NC 27713-8909
(817) 428-2404

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
207903
NC
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/24/2012
Last updated
01/06/2018
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