Individual
DR. JEREMY DON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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