Individual
DR. JOHN D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2003 MEDICAL PARKWAY, SUITE 100, ANNAPOLIS, MD 21401
(410) 573-1110
(410) 266-0714
Mailing address
2003 MEDICAL PARKWAY, SUITE 100, ANNAPOLIS, MD 21401
(410) 573-1110
(410) 266-0714
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D30718
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003
BCBS DC
—
01
—
0400065
UNITED HEALTH CARE
MD
01
—
110046029
MEDICARE RAILROAD
—
01
—
1496254
UNITED MINE WORKERS ASSOC
—
05
—
157531700
—
MD
01
—
260079
MAMSI
—
01
—
39833001
BCBS MARYLAND
—
01
—
4086280
AETNA
—
01
—
P0417
PRINCIPAL
MD
01
—
P11674
BCBS POINT OF SERVICE
—
Enumeration date
09/20/2006
Last updated
02/03/2010
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