Individual
DR. JEREMY DON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DEPT. OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5601
(601) 984-6665
Mailing address
2500 N STATE ST, UMMC-DEPARTMENT OF DERMATOLOGY, JACKSON, MS 39216-4500
(601) 815-3374
(601) 815-6613
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20241
MS
207R00000X
Internal Medicine Physician
T-1892
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02585707
—
MS
01
—
P01402453
RR MEDICARE
MS
Enumeration date
05/24/2007
Last updated
10/06/2017
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