Individual
GREGORY R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 MERCY HOSPITAL, ALEGENT MERCY HOSPITAL, COUNCIL BLUFFS, IA 51503
(712) 328-5000
Mailing address
PO BOX 4460, OMAHA, NE 68104
(866) 491-5807
(913) 491-0411
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
17050
NE
2085R0202X
Diagnostic Radiology Physician
Primary
26056
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17050
LICENSE #
NE
01
—
207
MIDLANDS
—
01
—
26056
IA LICENSE #
—
01
—
35534
BCBS
NE
05
—
4043109
—
IA
01
—
41360
BCBS
IA
05
—
5043109
—
IA
05
—
6043109
—
IA
05
—
7043109
—
IA
05
—
8043109
—
IA
01
—
AJ2110310
IA CONTROLLED SUBSTANCE
—
Enumeration date
06/20/2006
Last updated
03/07/2023
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