Individual
ALLEN THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S RIDGEWOOD AVE, DAYTONA BEACH, FL 32114-6123
(386) 492-7718
(386) 492-7720
Mailing address
1201 S RIDGEWOOD AVE, DAYTONA BEACH, FL 32114-6123
(386) 492-7718
(386) 492-7720
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME80695
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001628800
—
FL
Enumeration date
05/16/2006
Last updated
03/07/2023
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