Doctor Name: | MR. JOHN JACKSON |
NPI Number: | 1184607541 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | ME37656 |
Business Practice Address: | 777 E 25th St Suite 418 Hialeah, FL - 330133825 |
Business Phone Number: | 3058363533 |
Business Fax Number: | 3058368446 |
Mailing Address: | 777 E 25th St, Suite 418 HIALEAH |
State: | FL |
Postal Code: | 330133825 |
Phone Number: | 3058363533 |
Fax Number: | 3058368446 |
NPI Enumeration Date: | 11/21/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME37656 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |