Individual
MR. LARRY ARTHUR JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1445 GATEWAY BLVD, COTTAGE GROVE, OR 97424-1224
(541) 942-7000
(541) 942-5550
Mailing address
PO BOX 607, COTTAGE GROVE, OR 97424-0026
(541) 942-7000
(541) 942-5550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD08513
OR
Other
Enumeration date
04/29/2010
Last updated
04/29/2010
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