Individual
DR. LENLEY BRADFORD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2505 W HAMMER LN, STOCKTON, CA 95209-2839
(209) 954-4040
(209) 951-2239
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
(800) 470-0071
(916) 854-6769
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
15431
HI
207P00000X
Emergency Medicine Physician
Primary
A87877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119364
—
IL
01
—
833120
MEDICARE GROUP #
IL
01
—
CA2264
RAILROAD MEDICARE GROUP PTAN
IL
01
—
P00601866
RAILROAD MEDICARE MEMBER PTAN
IL
01
—
R00965
MEDICARE INDIVIDUAL #
IL
Enumeration date
10/01/2006
Last updated
01/12/2026
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