Individual
J CARVEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
303 N CENTENNIAL WAY, MESA, AZ 85201-6733
(480) 649-3111
(480) 649-3113
Mailing address
303 N CENTENNIAL WAY, MESA, AZ 85201-6733
(480) 649-3111
(480) 649-3113
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
2543
AZ
208100000X
Physical Medicine & Rehabilitation Physician
2543
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111328
—
AZ
Enumeration date
04/03/2006
Last updated
02/02/2023
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