Individual
DR. SCOTT M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4375 N VANTAGE DR STE 305, FAYETTEVILLE, AR 72703-4984
(479) 273-7006
Mailing address
4375 N VANTAGE DR STE 305, FAYETTEVILLE, AR 72703-4984
(479) 443-5100
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
E13748
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261960001
—
AR
Enumeration date
03/27/2007
Last updated
02/22/2022
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