Individual
DR. LEWIS JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 575-3388
Mailing address
7125 BAY DR, APT202, MIAMI BEACH, FL 33141-5476
(305) 867-2676
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME94517
FL
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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