Individual
DR. PHILLIP COREY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
1417 GLADDEN ST, HARRISON, AR 72601-5121
(870) 741-0016
(870) 741-4242
Mailing address
1417 GLADDEN ST, HARRISON, AR 72601-5121
(870) 741-0016
(870) 741-4242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E3074
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146189001
—
AR
01
—
5M007
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/26/2006
Last updated
08/11/2014
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