Individual
JO A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4245 ROOSEVELT WAY NE, SEATTLE, WA 98105-6008
(206) 598-4055
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00020270
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0231417
L&I
WA
05
—
1285750190
—
WA
Enumeration date
03/22/2007
Last updated
01/12/2012
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