Individual
STEPHEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDCS, RVT
Contact information
Practice address
2577 SAWGRASS LAKE CT, CAPE CORAL, FL 33909-2935
(202) 277-1063
Mailing address
2577 SAWGRASS LAKE CT, CAPE CORAL, FL 33909-2935
(202) 277-1063
Taxonomy
Speciality
Code
Description
License number
State
246XC2903X
Vascular Specialist/Technologist Cardiovascular
105942
FL
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
105942
FL
Other
Enumeration date
03/11/2015
Last updated
03/11/2015
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