Individual
DR. EDWARD A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7975 LAKE UNDERHILL RD STE 200, ORLANDO, FL 32822-8204
(407) 303-6830
(407) 303-8659
Mailing address
7975 LAKE UNDERHILL RD STE 200, ORLANDO, FL 32822-8204
(407) 303-6830
(407) 303-8659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301046128
MI
207Q00000X
Family Medicine Physician
Primary
ME129390
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0730985
BCBSM PIN
MI
01
—
080G376200
BCBSM GROUP NUMBER
MI
01
—
0G37620004
RAILROAD MEDICARE
MI
01
—
101977
GREAT LAKES HEALTH PLAN
MI
05
—
1639104029
—
MI
01
—
381870664
PRIORITY HEALTH
MI
01
—
381870664112
COMMUNITY CHOICE MICHIGAN
MI
01
—
4045995
AETNA
MI
01
—
EJ046128
LICENSE
MI
Enumeration date
07/12/2006
Last updated
07/21/2022
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