Individual
DONALD E JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6716 NW 11TH PLACE, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
Mailing address
6716 NW 11TH PLACE, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
ME60317
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME60317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054764600
—
FL
01
—
12766
BCBS FL
FL
01
—
1740238153
TRICARE PRIME
—
01
—
239216
AVMED
FL
01
—
270855
AVMED
FL
01
—
P00316730
RAIL ROAD MEDICARE
FL
01
—
P00328037
RAILROAD MEDICARE
FL
Enumeration date
05/05/2006
Last updated
03/15/2022
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