Organization
JAMES JACKSON D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES JACKSON SR. DO (OWNER)
23173955574
Entity
Organization
Contact information
Practice address
2416 PECK STREET, JAMES JACKSON D.O., P.C., MUSKEGON HTS., MI 49444
(231) 739-5574
(231) 739-5574
Mailing address
2416 PECK STREET, JAMES JACKSON D.O., P.C., MUSKEGON HTS., MI 49444
(231) 739-5574
(231) 739-5574
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JJ004758
MI
208D00000X
General Practice Physician
5101004758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006466
—
MI
Enumeration date
07/07/2010
Last updated
10/08/2010
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