Individual
DR. EDWARD C JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
269 S CANDY LN, COTTONWOOD, AZ 86326-4158
(928) 639-6172
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
58317
AZ
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
58317
AZ
207Q00000X
Family Medicine Physician
Primary
58317
AZ
Other
Enumeration date
06/07/2012
Last updated
03/02/2021
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