Individual
DR. JAY A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9119 W 74TH ST, SUITE 350, SHAWNEE MISSION, KS 66204-2215
(913) 789-3290
(913) 789-3208
Mailing address
9119 W 74TH ST, SUITE 350, SHAWNEE MISSION, KS 66204-2215
(913) 789-3290
(913) 789-3208
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R8D86
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100168130J
—
KS
05
—
1558360743
—
MO
05
—
201986726
—
MO
Enumeration date
07/19/2005
Last updated
09/11/2013
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