| Doctor Name: | DR. MATTHEW WESLEY JACKSON |
| NPI Number: | 1497014351 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 275775 |
| Business Practice Address: | 200 Madison Ave Ste 2b Elmira, NY - 149013219 |
| Business Phone Number: | 6077321310 |
| Business Fax Number: | |
| Mailing Address: | 1306 Twin Oaks S, HORSEHEADS |
| State: | NY |
| Postal Code: | 148453304 |
| Phone Number: | 2393408064 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2012 |
| NPI Last Update Date: | 01/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 275775 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |