Individual
DR. ANTHONY L JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2575 E BIDWELL ST STE 160, FOLSOM, CA 95630-6446
(916) 865-1400
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G43207
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G432070
—
CA
Enumeration date
06/20/2006
Last updated
11/04/2020
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