Individual
RICK LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5512 NE 107TH AVE, VANCOUVER, WA 98662-6169
(360) 892-2030
Mailing address
5512 NE 107TH AVE, VANCOUVER, WA 98662-6169
(360) 892-2030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34978
OR
207Q00000X
Family Medicine Physician
G47036
CA
207Q00000X
Family Medicine Physician
Primary
MD00019032
WA
Other
Enumeration date
01/30/2007
Last updated
06/25/2010
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