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Individual

DR. MICHAEL L JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
411 W TIPTON ST, SEYMOUR, IN 47274-2363
(812) 522-2349
Mailing address
1155 W 3RD ST, BLOOMINGTON, IN 47404-5016
(812) 336-1690
(812) 349-1311

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01032507A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01032507A
IN LICENSE
IN
01
01032507B
CSR
IN
05
100331130
IN
Enumeration date
08/31/2006
Last updated
03/07/2023
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