Jackson, Douglas

Jackson, Douglas is an individual health care provider with primary practice located at 934 Center St , Elgin IL 60120-2125. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Jackson, Douglas can be contacted via phone (847) 429-8750.

Contact Information

Primary practice address
934 Center St Elgin IL 60120-2125
Fax: (847) 429-8978
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036057410 Illinois

Profile Details

NPI number 1083612857
LBN Legal business name Jackson, Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Jul 8th, 2007 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083612857 NPPES
Illinois MEDICAID 03607410
Illinois Other 04532206

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