Individual
DR. LARRY K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2660 10TH AVE S, SUITE 528, BIRMINGHAM, AL 35205-1605
(205) 933-9258
(205) 933-6504
Mailing address
2660 10TH AVE S, SUITE 528, BIRMINGHAM, AL 35205-1605
(205) 933-9258
(205) 933-6504
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
00006718
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410564
UNITED HEALTHCARE
AL
01
—
51087222
BLUE CROSS
AL
01
—
87222
CIGNA
AL
Enumeration date
06/09/2006
Last updated
01/22/2010
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