Organization
CMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKSON DAVID FRASER (PA-C)
(209) 507-7000
Entity
Organization
Contact information
Practice address
1801 E MARCH LN STE D470, STOCKTON, CA 95210-6677
(209) 507-7000
(209) 507-7550
Mailing address
1801 E MARCH LN STE D470, STOCKTON, CA 95210-6677
(209) 507-7000
(209) 507-7550
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA22498
CA
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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