Individual
GRANT WELLS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
319 E PIONEER AVE, GRANT W JACKSON MD PS, MONTESANO, WA 98563-4601
(360) 249-1980
(360) 249-1993
Mailing address
319 E PIONEER AVE, GRANT W JACKSON MD PS, MONTESANO, WA 98563-4601
(360) 249-1980
(360) 249-1993
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ML002797
PA
207Q00000X
Family Medicine Physician
Primary
MD60002207
WA
207Q00000X
Family Medicine Physician
ML002797
PA
Other
Enumeration date
12/27/2006
Last updated
08/04/2008
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