Individual
JOHN T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11 FRIENDSHIP ST, NEWPORT, RI 02840-2271
(401) 845-1593
(401) 847-0650
Mailing address
11 FRIENDSHIP ST, NEWPORT, RI 02840-2271
(401) 845-1593
(401) 847-0650
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00132
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006480
—
RI
Enumeration date
04/28/2006
Last updated
04/10/2009
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