Individual
DONALD E JACKSON JR.
Active
Individual
DONALD E JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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