Individual
JONATHAN CAREY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2499
(206) 744-3000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00027698
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110099629
RAIL ROAD MEDICARE
WA
05
—
8122244
—
WA
01
—
9049
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
01/05/2012
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