Individual
THOMAS MILES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
04-21320
KS
208600000X
Surgery Physician
5568
AK
208600000X
Surgery Physician
Primary
DR48817
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100131110B
—
KS
Enumeration date
07/26/2005
Last updated
05/12/2010
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