Individual
DR. BILLY MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3917 WEST RD, SUITE 150, LOS ALAMOS, NM 87544
(505) 662-4351
(505) 662-4351
Mailing address
3917 WEST RD, SUITE 150, LOS ALAMOS, NM 87544
(505) 662-4351
(505) 662-4351
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
72160
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18523
—
NM
Enumeration date
07/12/2005
Last updated
04/16/2008
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