Individual
DR. JAMES LAWRENCE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 JOSEPH DR STE B, MIDLAND, MI 48642-8636
(989) 631-2020
(989) 835-6686
Mailing address
400 JOSEPH DR STE B, MIDLAND, MI 48642-8636
(989) 631-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301050635
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0256160001
DMERC - MEDICARE
MI
01
—
104430921
MEDICAID (GLADWIN OFFICE)
MI
01
—
1427052091
NPI
MI
01
—
180032321
RAILROAD MEDICARE
MI
01
—
1805601441
BCBS
MI
05
—
3103914
—
MI
Enumeration date
06/10/2005
Last updated
02/22/2022
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