Individual
GREGORY PAUL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-2475
(847) 570-2942
Mailing address
2650 RIDGE AVE # 1223, EVANSTON, IL 60201-1700
(847) 982-3175
(847) 982-3394
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01059554A
IN
174400000X
Specialist
35393
WI
174400000X
Specialist
Primary
—
IL
2085R0202X
Diagnostic Radiology Physician
Primary
036088433
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088433
—
IL
Enumeration date
12/27/2005
Last updated
03/25/2026
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