Individual
MICHAEL GERARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2352 BRUCE B DOWNS BLVD STE 205, WESLEY CHAPEL, FL 33544-9203
(813) 991-7416
(813) 355-5097
Mailing address
38135 MARKET SQ, ZEPHYRHILLS, FL 33542-7505
(352) 567-0188
(813) 528-4975
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
ME110404
FL
207VG0400X
Gynecology Physician
Primary
ME110404
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004120900
—
FL
01
—
P01024246
RR MEDICARE
FL
Enumeration date
06/19/2007
Last updated
06/14/2022
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