Individual
DR. MICHAEL DONIEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
205 WABASHA ST S, SAINT PAUL, MN 55107-1805
(952) 967-5584
Mailing address
2910 WESTOWN PKWY STE 200, WEST DES MOINES, IA 50266-1332
(515) 223-7773
(402) 939-0407
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
37062
IA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
37998
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IN PROCESS
—
IA
Enumeration date
04/25/2007
Last updated
08/16/2024
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