Individual
DR. LELAND JAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5006 W GENESEE ST, CAMILLUS, NY 13031-2326
(315) 234-2342
(315) 234-0697
Mailing address
5006 W GENESEE ST, CAMILLUS, NY 13031-2326
(315) 234-2342
(315) 234-0697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
171536
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01348347
—
NY
01
—
171536
STATE LICENSE NUMBER
NY
Enumeration date
02/03/2006
Last updated
03/07/2023
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