Individual
DANIEL FORREST JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
480 HONEYSUCKLE RD, DOTHAN, AL 36305
(334) 836-1212
(334) 836-1888
Mailing address
480 HONEYSUCKLE RD, DOTHAN, AL 36305
(334) 836-1212
(334) 836-1888
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
11900
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00301254A
—
GA
01
—
1199413
UNITED HEALTHCARE
—
01
—
P00229127
RAILROAD MEDICARE
—
Enumeration date
05/19/2006
Last updated
07/08/2007
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