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Individual

MR. DAVID M JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1133 SAXON BLVD, PROMPT CARE, ORANGE CITY, FL 32763-0000
(904) 305-3221
Mailing address
2223 ASTOR ST, PA2, ORANGE PARK, FL 32073-5668
(904) 305-3221

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
01108408409
VA
363AM0700X
Medical Physician Assistant
Primary
9104510
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003373900
FL
01
Y06YY
BCBS
Enumeration date
06/28/2006
Last updated
08/01/2012
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