Individual
DR. MATTHEW J JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
243 CHARLES STREET, MASS EYE AND EAR INFIRMARY, BOSTON, MA 02114
(617) 573-4306
(617) 659-4917
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
11607
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0264822
—
MA
01
—
40346
HARVARD PILGRIM HMO
MA
01
—
757863
TUFTS HEALTH HMO
MA
Enumeration date
11/21/2005
Last updated
07/08/2007
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