Individual
MATTHEW R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1225 W FRONT ST, TRAVERSE CITY, MI 49684-2368
(231) 935-0788
(231) 935-0787
Mailing address
1225 W FRONT ST, TRAVERSE CITY, MI 49684-2368
(231) 935-0788
(231) 935-0787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101018472
MI
207QS0010X
Sports Medicine (Family Medicine) Physician
34.010954
OH
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
5101018472
MI
Other
Enumeration date
09/02/2009
Last updated
12/21/2020
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