Individual
DR. TIMOTHY K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
710 GENESIS BLVD, BRIDGEPORT, WV 26330-9668
(681) 342-3070
Mailing address
PO BOX 763, MORGANTOWN, WV 26507-0763
(800) 541-4009
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
13532
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0084315000
—
WV
Enumeration date
08/17/2006
Last updated
04/06/2022
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