Individual
MR. DEWEY THOMAS JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2828 BAIRD RD, FAIRPORT, NY 14450-1247
(585) 248-9670
(585) 248-0384
Mailing address
2828 BAIRD RD, FAIRPORT, NY 14450-1247
(585) 248-9670
(585) 248-0384
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
136492
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100843BJ
PREFERRED CARE
NY
01
—
10162610
BLUE CHOICE
NY
Enumeration date
03/22/2006
Last updated
07/08/2007
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