Individual
DOUGLAS T JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 BARGEN ST, F 102, NEWARK, NJ 07103
(973) 972-3555
(973) 972-3510
Mailing address
PO BOX 18925, NEWARK, NJ 07191
(973) 972-3555
(973) 972-3510
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
25MA06601400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6716407
—
NJ
Enumeration date
01/26/2006
Last updated
07/08/2007
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