Individual
MS. MOLLIE J JACKSON
Active
Individual
MS. MOLLIE J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02003644
IN
207R00000X
Internal Medicine Physician
02003644A
IN
207RG0100X
Gastroenterology Physician
Primary
05-37265
KS
208M00000X
Hospitalist Physician
02003644A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200984700
—
IN
05
—
200984700
—
KS
Enumeration date
05/29/2008
Last updated
07/22/2014
Update your record
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