Organization
VAUGHN D JACKSON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAUGHN D JACKSON M.D. (SOLE MEMBER)
(719) 274-4500
Entity
Organization
Contact information
Practice address
412 MAIN, LA JARA, CO 81140
(719) 274-4500
(719) 274-4504
Mailing address
P.O. BOX 272, 416 MAIN, LA JARA, CO 81140
(719) 274-4500
(719) 274-4504
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
31351
CO
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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