Individual
LEE SA B. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4824 E BASELINE RD, SUITE 110, MESA, AZ 85206-4676
(480) 615-2020
(480) 219-9957
Mailing address
4824 E BASELINE RD, STE 110, MESA, AZ 85206-4678
(480) 615-2020
(480) 219-9957
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25793
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
404731
—
AZ
Enumeration date
11/02/2005
Last updated
11/18/2024
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