Organization
LESLIE JACKSON, MD
Active
Other names
TAYLORVILLE FAMILY CARE, LTD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE JACKSON MD (PRESIDENT)
(217) 824-3757
Entity
Organization
Contact information
Practice address
115 E PLEASANT ST, TAYLORVILLE, IL 62568-1560
(217) 824-3757
(217) 824-9604
Mailing address
115 E PLEASANT ST, P O BOX 318, TAYLORVILLE, IL 62568-1560
(217) 824-3757
(217) 824-9604
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036072876
IL
Other
Enumeration date
01/30/2008
Last updated
06/24/2008
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