Individual
MRS. DOREEN ONIPEDE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 BODIN CIRCLE, TRAVIS AIR FORCE BASE, CA 94535-1800
(919) 753-6879
Mailing address
101 BODIN CIRCLE, DAVID GRANT MEDICAL CENTER - TRAVIS AIR FORCE BASE, FAIRFIELD, CA 94535
(919) 753-6879
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
171636
CA
208C00000X
Colon & Rectal Surgery Physician
Primary
171636
CA
208C00000X
Colon & Rectal Surgery Physician
ME139661
FL
208D00000X
General Practice Physician
204413
NC
Other
Enumeration date
05/09/2013
Last updated
08/19/2022
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