Individual
MR. CECIL TIMOTHY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
90 HIGHWAY 91 SOUTH, C/O BARRETT HOSPITAL & HEALTHCARE, DILLON, MT 59725-3597
(406) 683-3000
(406) 683-3011
Mailing address
203 S DAISY ST, SALMON, ID 83467-4709
(208) 756-2429
(208) 756-2429
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
29774
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29774
STATE LICENSE NUMBER
MT
Enumeration date
06/06/2006
Last updated
10/13/2016
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