Individual
PHILIP JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301025901
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0994622
HEALTH PLUS MMMI
MI
01
—
1020381
MCLAREN HEALTH PLAN HAN
MI
01
—
1437174638
NPI
MI
01
—
17572
MCARE MMMI
MI
01
—
350D410030
BCN BLUE CHOICE FENTON
MI
05
—
4737508
—
MI
05
—
4859153
—
MI
01
—
700H228520
BCBSM
MI
Enumeration date
07/12/2006
Last updated
10/21/2009
Update your record
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