Individual
MR. GILLIAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
483 W. SEED FARM RD., SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Mailing address
PO BOX 38, SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT30262
AZ
Other
Enumeration date
12/19/2005
Last updated
11/12/2015
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