Jackson, Gregory Paul

Jackson, Gregory Paul is an individual health care provider with primary practice located at 2650 Ridge Ave , Evanston IL 60201-1700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jackson, Gregory Paul can be contacted via phone (847) 570-2475.

Contact Information

Primary practice address
2650 Ridge Ave Evanston IL 60201-1700
Phone: (847) 570-2475
Fax: (847) 570-2942
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036088433 Illinois

Profile Details

NPI number 1649257163
LBN Legal business name Jackson, Gregory Paul
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2005
Last updated Mar 25th, 2026 - about 7 months 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 1649257163 NPPES
Illinois MEDICAID 036088433

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