Individual
JACKSON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(024) 294-2056
Mailing address
3601 4TH ST, LUBBOCK, TX 79430-0002
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/15/2024
Last updated
05/29/2024
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