Individual
MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5537B N GLENWOOD ST STE B, GARDEN CITY, ID 83714-1336
(208) 789-9075
(208) 917-2818
Mailing address
PO BOX 326, MERIDIAN, ID 83680-0326
(208) 890-9750
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NA
ID
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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