Individual
ANTHONY W JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 337-7409
(252) 337-7410
Mailing address
105 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 337-7409
(252) 337-7410
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2007-00605
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14516
BCBSNC
NC
05
—
5906945
—
NC
Enumeration date
09/26/2006
Last updated
01/07/2011
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