Individual
FREDRIC NEVEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PS
Contact information
Practice address
16259 SYLVESTER RD SW, STE 404, BURIEN, WA 98166-3049
(206) 241-1818
(206) 244-3991
Mailing address
16259 SYLVESTER RD SW STE 404, BURIEN, WA 98166-3059
(206) 241-1818
(206) 244-3991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00019031
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00019031
WA
207RP1001X
Pulmonary Disease Physician
MD00019031
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110046684
RR MEDICARE
WA
05
—
1783901
—
WA
Enumeration date
08/23/2005
Last updated
05/12/2014
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