Individual
STEPHANIE L JACKSON
Active
Individual
STEPHANIE L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
51415
AZ
207R00000X
Internal Medicine Physician
MD23663
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120461
—
AZ
05
—
286902
—
OR
Enumeration date
01/25/2006
Last updated
07/25/2016
Update your record
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