Individual
FREDERIC LESLIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Contact information
Practice address
2402 OLD RANCH RD, ESCONDIDO, CA 92027-6727
(760) 855-5423
(877) 359-0651
Mailing address
2402 OLD RANCH RD, ESCONDIDO, CA 92027-6727
(760) 855-5423
(877) 359-0651
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102032316
VA
207Q00000X
Family Medicine Physician
OS0004196
FL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
20A10056
CA
Other
Enumeration date
11/28/2006
Last updated
12/13/2008
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