Individual
JARED JACKSON
Active
Individual
JARED JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
29168
OK
261QM2500X
Medical Specialty Clinic/Center
29168
OK
390200000X
Student in an Organized Health Care Education/Training Program
11016020A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200752480A
—
OK
Enumeration date
06/29/2011
Last updated
04/21/2020
Update your record
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