Individual
JEFFREY I JACKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
640 S STATE STREET, DEPT OF RADIOLOGY, DOVER, DE 19901-3530
(302) 674-2202
Mailing address
10850 W PARK PL STE 1100, MILWAUKEE, WI 53224-3636
(414) 359-5745
(414) 359-5703
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
C20004119
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000601403
—
DE
Enumeration date
01/18/2006
Last updated
03/01/2012
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