| Organization Name: | LARRY A. JACKSON, MD PC |
| NPI Number: | 1134565849 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY ARTHUR JACKSON (PRESIDENT) |
| Mailing Address: | 1717 Centennial Blvd Suite 7 Springfield |
| State: | OR US |
| Postal Code: | 974773378 |
| Phone Number: | 5417260550 |
| Fax Number: | 5417267485 |
| NPI Enumeration Date: | 05/21/2013 |
| NPI Last Update Date: | 05/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 08513 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |