Individual
NEIL CHRISTOPHER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2022 E AZTEC AVE, GALLUP, NM 87301-4804
(505) 397-5172
Mailing address
615 VANDENBOSCH PKWY, GALLUP, NM 87301-4537
(412) 445-4695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2019-0691
NM
Other
Enumeration date
06/23/2014
Last updated
01/05/2024
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