Individual
DR. JACKSON MESSENGER CONDREY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35878
SC
207L00000X
Anesthesiology Physician
LL35878
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL35878
LIMITED MEDICAL LICENSE NUMBER
SC
Enumeration date
06/18/2013
Last updated
07/21/2022
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