Individual
JAMES C JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1020688
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000022017
MEDICARE TRAVELERS PIN
AL
05
—
000022017
—
AL
05
—
105361
—
AL
01
—
CN0216
MEDICARE TRAVELERS
AL
Enumeration date
02/14/2006
Last updated
01/30/2009
Update your record
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