Individual
JAMES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-3744
Mailing address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
(574) 293-3744
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001724A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200482280
—
IN
Enumeration date
11/03/2005
Last updated
08/12/2016
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