Individual
DR. DEIDRYA ANTOINETTE ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD MPH
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Mailing address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Taxonomy
Speciality
Code
Description
License number
State
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
278459
MA
Other
Enumeration date
05/07/2015
Last updated
05/21/2019
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